Apartment Needs

* Required

Before filling out application, please call (260) 484-3239 to check for availability.

You must be 21 years old to apply.

Apartment Size *

Date Apartment Needed: *

Personal Information

First Name *

Mi *

Last Name *

If you do not have a middle name type "n"

Phone Number: *

Email: *

Date of Birth: *

Drivers License#: *

Social Security: *

Present Housing

Street Address: *

City: *

State: *

Zip: *

Housing Type: *

Length of Residency *

Present Landlord's Name:

Present Landlord's Phone #:

Present Landlord's Street Address:

City:

State:

Zip:

Previous Housing

Street Address:

City:

State:

Zip:

Housing Type:

Length of Residency *

Previous Landlord's Name:

Previous Landlord's Phone #:

Previous Landlord's Street Address:

City:

State:

Zip:

Present Employment Information

Employer: *

Street Address: *

City: *

State: *

Zip: *

Employer Phone: *

Supervisor: *

How long have you been employed? *

Annual Salary: *

Previous Employment Information

Employer:

Street Address:

City:

State:

Zip:

Employer Phone:

Supervisor:

How long have you been employed?

Pet Information

Do you own a pet: *

Yes

Pet Type *

List Dependants living with you

List your Automobiles

Emergency Contact

Emergency Contact Name: *

Relationship: *

Phone Number: *

Questions:

Have you ever broken a lease or been evicted or had your lease terminated by your landlord? *

Yes

Date:

If yes please explain:

Have you ever plead guilty or been convicted of a crime? *

Yes

If yes please explain:

Digitally Signed by Applicant: *

Email: *

I understand that I will need to pay a security deposit upon approval: *
Yes
No

Disclaimer

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