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EXPRESS APPLICATION FORM
First Name:
Last Name:
Contact Information (Email):
Current Address:
Date of Birth:
Current Landlord’s Name:
Current Landlord’s Contact Information (Email/Phone):
Reason for Leaving Current Residence:
Previous Addresses (Last 5 years):
Length of Stay at Previous Residences:
Previous Monthly Rent:
Any Evictions in the Last 7 Years? (Yes/No):
Yes
No
Reason for Eviction (if applicable):
Current Employer:
Position::
Employer’s Contact Information:
Length of Employment:
Monthly Income (Net):
Previous Employment (If less than 2 years at current job):
Other Sources of Income:
Total Monthly Debts/Obligations:
Are you currently under bankruptcy or have you filed for bankruptcy in the past 7 years? (Yes/No):
Yes
No
Personal Reference 1 (Name and Contact Information):
Personal Reference 2 (Name and Contact Information):
Name of Occupants:
Relationship of Other Occupants to Applicant:
Pets? (Yes/No) If yes, please specify:
Yes
No
If yes, please specify:
Do you have renter’s insurance? (Yes/No):
Yes
No
Any special requests or needs? (e.g. accessibility requirements):
Any other relevant information you’d like to provide?
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