Property Address - None -110 S. Broom Street112 S. Broom Street408 W. Doty Street410 W. Doty Street412 W. Doty Street, Unit 1412 W. Doty Street, Unit 2412 W. Doty Street, Unit 3 Lease From Lease To Number of Tenants to Occupy Apartment APPLICANT INFORMATION: (Each adult applicant must complete a separate application) First Name Middle Name Last Name Phone Email Gender Date of Birth Auto Make Auto Model Auto License Plate Number EMERGENCY CONTACT INFORMATION Emergency Contact Information First and Last Name Email Phone Street Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code RENTAL HISTORY INFORMATION Current Address Apt Number City State Zip Code How Long? Monthly Rent? Utilities Included, if no, which do you pay for? Current Landlord Name & Phone Number If Less Than One Year, Prior Address Prior Street Address Prior Apt Number Prior City Prior State Prior Zip Code Prior How Long? Prior Monthly Rent? Prior Utilities Included, if no, which do you pay for? Prior Landlord Name & Phone Number Have you ever been evicted or served an eviction notice? Yes No EMPLOYMENT INFORMATION: Employer/Company Name Position Supervisor Employer Phone Duration of Employment Gross Monthly Income Other Sources of Income Parents $ / Fin. Aid $ / Grants $ / Other $ STUDENT INFORMATION: College / University Name Major Graduation Year Enrollment Status Full-time Part-time List all residents who will occupy apartment: Additional First Name Additional Last Name Age Additional Occupant Email Additional Occupant Phone Rental Applicant Signature Applicant Signature Date This Application is not a rental agreement, contract or lease. All applications are subject to approval of owner or managing agent. Yes To the best of my knowledge, all of the above information is true and complete. Yes I give Belle Properties permission to receive housing information from resent and past Landlords. I further give Belle Properties permission to contact my Employer to verify my employment status and income.
