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Today's Date:

(mm/dd/yyyy) *

General Information

Last Name:

First Name:

Birth Date:

(mm/dd/yyyy) *

Social Security Number:

(xxx-xx-xxxx)*

Drivers License/State ID:

Email:

Phone - Home:

Phone - Work:

Phone - Mobile:

Car #1:

Car #2:

Current Addres

Present Address:

Suite/Apt#:

City:

, Zip: *

How long at this address?:

Reason for Leaving:

Landlord's Name:

Landlord's Phone:

Monthly Payment:

Employment

Current Employer:

Length of Employment:

Contact Person:

Phone #:

Monthly Take Home Wage:

Other Monthly Income

Amount:

Source:

Contact Person:

Phone:

Amount:

Source:

Contact Person:

Phone:

Amount:

Source:

Contact Person:

Phone:

Amount:

Source:

Contact Person:

Phone:

Family Information

Dependents under 18 years of age (ALL occupants 18 and over must submit an application)

# of Minor Occupants

	Name	DOB (mm/dd/yyyy)
Dependent 1
Dependent 2
Dependent 3
Dependent 4

Other Information

Number of Bedrooms Needed:

Do you have any felonies:

How Many Pet(s):

Kind of Pet(s), Breed:

Has Applicant Ever:

Been sued for non-payment of rent:

Been evicted or asked to move out:

Broken a Rental Agreement or Lease:

Declared Bankruptcy:

Do You Currently Pay Child Support:

In case of personal emergency, notify:

Relationship:

Phone #:

References

Parent(s) Name:

Address:

Phone:

Name:

Phone:

Address:

Name:

Phone:

Address:

Name:

Phone:

Address:

The application fee is $25.00 per applicant and is non-refundable. I hereby authorize the landlord to verify any and all information on this application, criminal report and/or on a credit report. I/We, the undersigned, authorize United Properties of West Michigan to obtain credit information from Merchant Service Bureau/CBC Companies, other Credit Bureau or any other screening service, which MAY include credit history, rental history, criminal history, sexual offender history and terrorist information for the purpose of determing eligibility to lease an apartment or house or to obtain collections information.

(View Application Terms and Conditions)

Authorization Signature:

Date:

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