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 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.