Address you are applying for:
Date of desired occupancy:
Would you like to take advantage of our Owner Financing or Lease Purchase (check one)
How much of a down payment can you raise? Is your credit, good, fair, or ugly?
What is the maximum monthly payment you would/could pay?  

YOUR PERSONAL INFORMATION

Full Name:
Phone: Work Phone: SS #:
Driver's License # State: Date of Birth:
Present Address:
City: State: Zip: How Long?
If renting, Apartment name/location:
Landlord/mgr's name: Phone:
Why did you leave?

Employer #1: Position: How Long:
Address: Phone:
Gross Monthly Income Before Deductions:

Employer #2: Position: How Long:
Address: Phone:
Gross Monthly Income Before Deductions: Other Income: Source:
Spouse Name: SS#: Gross Monthly Income:

CREDIT INFORMATION: This can include store credit cards, rental stores,
car loans, small loans, etc.

Bank: Branch: Checking Acct #:
Bank: Branch: Saving Acct #:    
Bank: Branch: Loan Acct #:       

LIST ALL OF YOUR CURRENT MONTHLY OBLIGATIONS:

Pay To: Total Amount Due: Monthly Payment:
Pay To: Total Amount Due: Monthly Payment:
Pay To: Total Amount Due: Monthly Payment:
Pay To: Total Amount Due: Monthly Payment:
Pay To: Total Amount Due: Monthly Payment:
Pay To: Total Amount Due: Monthly Payment:

Have you ever been evicted? YES: NO: If Yes, Explain:
Have you ever filed for bankruptcy? NO: YES: Date: Chap.7: Chap.13:
If YES, has the bankruptcy been discharged? YES: NO: If Yes, when?

Have you ever been convicted of a crime, other than a traffic violation? YES: NO:

If YES to the above question, Explain:

OTHER INFORMATION
OTHER PERSONS (INCLUDING CHILDREN) WHO WILL LIVE IN THE PROPERTY

Name: Name:
Name: Name:

We will need a separate Application from every person over 18 residing at the property
including Husband and Wife.

  I declare that the application is complete, true and correct and I herewith give my permission for anyone contacted to
release the credit or personal information of the undersigned applicant to Management or their Authorized Agents, at
any time, for the purposes of entering into and continuing to offer or collect on any agreement and/or credit extended. 
I further authorize Management or their Authorized Agents to verify the application information including but not limited
to obtaining criminal records, contacting creditors, present or former landlords, employers and personal references,
whether listed or not, at the time of the application and at any time in the further, with regard to any agreement entered
into with Management.  Any false information will constitute grounds for rejection of this application, or Management
may at any time immediately terminate any agreement entered into in reliance upon misinformation given on the application.

Applicant: Date: