Copy and email the completed form to Yachatsview@gmail.com, or print, complete the form and snail mail to the address above. ========================================================== Name (person): Date of Birth: SS No. Phone: Current Address: City: State: Zip: Monthly Rent: How Long? Landlord Name: Phone Number: Previous Address City: State: Zip: Monthly Rent: How long? Landlord Name: Phone No.: ============================================================ Employment Information Employers Name: Address: City: State: Zip: Phone: Fax: Previous Employer: Address: City: State: Zip: ============================================================= Emergency Contact Name of Relative not living with you: Address: City: State: Zip: Phone: ============================================================= Spouse/Roommate Information if applicable Name: Date of Birth: SS No. Phone: Current Address: City: State: Zip: Monthly Rent: How Long? Landlord Name: Phone No.: Previous Address City: State: Zip: Monthly Rent: How long? Landlord Name: Phone No.: =============================================================== Bank Information Bank Name: Phone Number: Address: City: State: Zip: Checking Account No.: Savings Account No.: ================================================================ Other Information HAVE YOU EVER: Filed for bankruptcy If yes, when? Been served an eviction notice or been asked to vacate a property you were renting/leasing? Willfully or intentionally refused to pay rent when due? ================================================================== Personal References Name Relationship Phone
Acknowledgment I/We the undersigned declare the foregoing information is true and correct, and I/We hereby authorize you to check our, credit, background and to verify our references.
___________________________________________________________________ Applicants Signature Date Co-Applicants Signature Date
