APARTMENT APPLYING FOR Apartment # Located at (address) Rent per month is ABOUT THE APPLICANT Your Name Your Age Your Cell Phone Your Email (required) Parent/Spouse Name Parent mailing address Your Parent/Spouse Email Your Parent/Spouse Phone Children Names & Ages PRESENT HOUSING INFORMATION Present Address From-To Dates Rent Owner/Manager Owner/Manager Phone Why vacating? Does the Owner know? If not, why? PREVIOUS HOUSING INFORMATION Previous Address From-To Dates Rent Owner/Manager Owner/Manager Phone APPLICANT EMPLOYMENT CURRENT EMPLOYER Employer Employer Phone Position held Name/Title of Supervisor Dates of Employment (From-To) Wages/Salary PREVIOUS EMPLOYER Previous Employer Previous Employer Phone Previous Position held Previous Employer Name/Title of Supervisor Dates of Previous Employment (From-To) Previous Employment Wages/Salary OTHER INCOME Other Sources of income APPLICANT REFERENCES REFERENCE #1 Personal Reference Name Address Phone Time Acquainted Occupation REFERENCE #2 Personal Reference Name Address Phone Time Acquainted Occupation APPLICANT VEHICLE Vehicle Make Vehicle Model Vehicle Color Vehicle License# Vehicle State EMERGENCY In Case of Emergency Notify (name/phone): I warrant that the information supplied is true and correct, and that I am at least 18 years of age. I agree to allow the owner to contact my current landlord for a written rental reference. I have been informed that the owner is a member of the Credit Bureau Services of Vermont, and may check my credit with CBSV to evaluate my qualifications as a potential tenant. Owner is allowed by contract with CBSV to report any rent delinquency or eviction proceedings to CBSV. Owner warrants that any verifications are for the purpose of entering into a Rental Agreement, and further warrants that any information derived from credit reports or other sources will be kept confidential and not revealed to any outside party. **The Security Deposit is to be paid by check** I understand that pressing the Submit button is submitting my signature.