Full Name:* Phone Number:* (ex: 555-555-5555) Date of Birth:* / / (ex: 04 / 15 / 1978) Social Security Number:* - - E-mail Address:*
Current Address: Street: * Apt/Suite: City/Town: * State:* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code:* - Current Landlord's Name::* Landlord's Phone Number::*
How long at this address?:* Reason for leaving:*
Previous Address: Street: * Apt/Suite: City/Town: * State:* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code:* -
Auto Make: Model: Year: State/License Plate #:
Present Employer: * Position: * Phone Number: * How Long at this Job: * Employer's Address: * City: * State:* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Mother's Maiden Name:
Have you ever been evicted from an apartment or house (place of dwelling)? * Yes No
Drivers License: * State: *
Personal References Name: * Relationship: * Yrs Known: * Phone: * Name: * Relationship: * Yrs Known: * Phone: *
Number of adults wanting to move in to the apartment/house: * Total number of living with you under the age of 18: *
Names and relations of all other applicants:
Please check all apartment preferences:
Floor: 1st 2nd 3rd Apartment Type: 1 Bdrm 2 Bdrm Corner
Building: Union Square 1 Union Square 2 Union Square 3 Roberta Linn
I certify that the answers given on this application are true and complete to the best of my knowledge. I give authorization to investigate all statements contained in this application for tenant screening as may be needed. I understand that the landlord may terminate any rental agreement entered into for any misrepresentations made above. Union Square will refund my deposit in full until you are called to sign a contract. Once you are called to sign a contract, $20.00 will be withheld from your deposit if a refund is requested. By entering your full name in the box below, it is as if you were signing the document and will be treated as such.
