APPLICATION - PALMS ALTUS

Name

First Name

Last Name

Email Address

Phone

Cell Phone/House Phone

(###)

###

####

Date of Birth

YYYY

Marital Status

Other Occupants

Anyone living with you in the apartment - Enter their name/names, relationship to you and their date of birth.

What Size Apartment Are You Looking For?

Move In Date

When Do You Want To Move In?

Pets?

Do you or any other member of the household have a pet?

If yes, what kind of pets and how much do they weigh?

Have you or any other household member ever broken a lease or been evicted?

If Yes, Explain:

Have You or anyone in your household ever been charged of a drug related crime?

If Yes, Explain:

Have you or anyone in your household ever been charged of the following crimes (misdemeanors & felonies) within the last ten year? (1) Drug use, including possession, delivery or manufacturing; (2) Sexual offenses; (3) Burglary; (4) Domestic violence; (5) Hate crimes, including crimes against persons; (6) Gang related activity.

If Yes, Which numbers? Please explain -

Where do you currently live?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of current Landlord or Property Manager

Landlord or Property Managers Contact #

(###)

###

####

Move in date to current residence

Current monthly rent:

Reason for moving from current residence:

Tell Us About Your Automobile:

Please include Year, Make/Model, Color, License Plate/State

Emergency Information

In case of emergency who should we contact? Please include name and phone number.

Is your emergency contact authorized to enter and remove your property in case of serious illness, accident or death?

Please List All Employment Income of Every Household Member:

Company Name

Supervisor Name

Contact Number

Position

Start Date

Gross Monthly Income