Rental Application Form

Full Name		Phone #		DOB
Spouse/Fiance		Phone #		DOB
E-mail		Other Contact Info
Preferred Move in Dates		Preferred Move in Building	Union Square 1 9 - Plex Union Square 2 Union Square 3 Roberta Linn Halliday House Sudweeks House
Current Address		City		State
Zip Code
Current Landlord's Name		How long at this Address		Landlord's Phone #
Reason for Leaving
Present Employer		Position		Phone #
How Long at This Job		Other Income Source
Employer's Address		City		State

Have you ever been evicted from an apartment or house?

# of Adults to live in Apartment/House

Total # of persons living with you under age 18

Personal References

Name   Relationship   Yrs Known   Phone

Name   Relationship   Yrs Known   Phone

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.

Signature   Date