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Property Information

Property You Are Applying For

Personal Information

First Name

Last Name

Date of Birth:

Social Security Number:

Home Phone

Cell Phone

Driver's License Number

Other Occupant (1) First Name

Other Occupant (1) Last Name

Relationship (1)

Other Occupant (2) First Name

Other Occupant (2) Last Name

Relationship (2)

Rental History

Current Address

City

State

Zip

Length of Residence

Landlord

Phone Number

Current Rent $/Month

Reason for Leaving

Previous Address

Previous City

Previous State

Previous Zip

Previous Landlord

Phone Number

Rent $/Month

Reason for Leaving

Employment History

Current Employer

Employer's Address

Current Position

Starting Date

How Long With this Employer

Supervisor's Name

Supervisor's Phone Number

Gross Annual Income $

Other Income $

Other Information

Is there a history of bed bugs in the dwelling you currently occupy?

If yes, Explain

Is there a history of bed bugs in the dwelling you previously occupied?

If yes, Explain

Automobile Make and Type

Year

Color

License Plate Number

In case of personal emergency, notify

(1) Name

Phone

Relationship

(2) Name

Phone

Relationship

Have you ever been convicted of a crime?

If yes, was it a misdemeanor or felony?

Acknowledgement

I hereby certify that all statements made above are correct

NOTE: You may obtain information about sex offender registry and persons registered with the registry by contacting the Wisconsin Department of Corrections on the Internet at http://www.widocoffenders.org or by phone at 877-234-0085

I certify that all of the information provided in this application is true to the best of my knowledge and that my rental agreement may be terminated if I have made any false or incomplete statements in this application. I authorize verification of the information provided in this application from my credit sources, current & previous landlords, employers and personal references.

My rental of said premesis is to be limited to use and occupancy by family of size and description above.

I authorize you to contact any references that I have listed, before, during or after my tenancy.

NOTE: A security deposit is require from every tenant against damage or loss to the premesis, and said security deposit cannot be used for the last month's rent.

At Lessor's discretion, but not based upon race, ethicity, religion or sexual orientation, specific qualifications and/or requirements may be established for specific apartment buildings; we reserve the right to reject applicants who do not meet these requirements.

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