Copy this page and paste it into a word processing program, complete it, then fax it to 770.924.7242

Make sure to include a current phone number so I can reach you. You may also pick up an application on site from Chris Bell when you visit the apartments.

SOCIAL SECURITY# ________________________Best Contact Phone # for You__________________

CO-APPLICANT _____________________ BIRTHDATE_____________

EMPLOYER________________________HOW LONG?____________Monthly Income__________

EMPLOYER NAME-CONTACT PHONE _____________________________________________________

CO-APPICANT EMPLOYER_____________________________HOW LONG?________Income________

CO-APPLICANT EMPLOYER'S CONTACT ________________________________________________

CURRENT PHONE NUMBER______________________CELL NUMBER_______________________

PRESENT ADDRESS________________________________________ZIP__________

HOW LONG AT PRESENT ADDRESS_________ REASON FOR MOVING____________________

CURRENT RENT: $_______CURRENT LANDLORD NAME________________

PREVIOUS ADDRESS_________________________ ZIP__________

RELATIONSHIPS TO SELF_______________________________AGES_____________________

LIST ANY PETS___________________________________________________________________

CAR MAKE__________ YEAR_____ ___MODEL___________ COLOR_______LIC.PLATE#________

CAR MAKE__________ YEAR________ MODEL___________ COLOR_______LIC.PLATE#____________

BANK REFERENCES PLEASE LIST AND INDICATE ALL SAVINGS (S) AND CHECKING (CK) ACCOUNTS

___________________________________________________________________________________________________________

EMERGENCY CONTACT WHO DO WE CONTACT IN CASE OF EMERGENCY?

___________________________________________________________________________________________________________

ADDRESS OF PREMISES OFFERED FOR RENT_______________LAWRENCE ST__________________________________________

I UNDERSTAND AND AGREE THAT SECURITY DEPOSIT MUST BE POSTED PRIOR TO THE EXECUTION OF A LEASE AGREEMENT IN CERTIFIED FUNDS, MONEY ORDER OR CASH.

I HEREBY DEPOSIT THE SUM OF $_250.00_ WITH THE LANDLORD/AGENT TO SECURE THE ABOVE PREMISES TO RENT, PENDING EXECUTION OF A LEASE AGREEMENT.

LANDLORD/AGENT AGREES THAT THE DEPOSIT IS REFUNDABLE IF THE ABOVE APPLICANT IS NOT APPROVED, PROVIDING THAT THIS APPLICATION HAS BEEN FILLED OUT COMPLETELY AND TRUTHFULLY.

HAVE YOU OWNED A HOME IN THE PAST? _______. IF YES, HOW LONG? ________. HOW MANY? __________.

HAVE YOU EVER FILED A PETITION FOR BANKRUPTCY?___________________ IF YES, WHEN?______________.

HAVE YOU EVER BEEN EVICTED FROM ANY TENANCY? ___________________.

HAVE YOU EVER WILLFULLY AND INTENTIONALLY REFUSED TO PAY RENT WHEN DUE?___________________.

I HEREBY AUTHORIZE LANDLORD/AGENT TO VERIFY THE VALIDITY OF ALL THE ABOVE INFORMATION, AND TO INQUIRE WITH

MY EMPLOYERS, FINANCIAL INSTITUTIONS, AND ANY OF THE CREDIT REPORTING BUREAUS AVAILABLE TO HIM. I AGREE TO SUPPLY ANY ADDITIONAL INFORMATION NEEDED BY OWNER/AGENT TO PROCESS THIS APPLICATION AND I ACKNOWLEDGE

THAT MY DEPOSIT WILL BE FORFEIT IF I DO NOT COMPLY WITH ANY SUCH REQUEST

I HEREBY ACKNOWLEDGE RECEIPT OF A COPY OF THIS APPLICATION AGREEMENT. I AGREE THAT LANDLORD MAY TERMINATE ANY AGREEMENT ENTERED INTO IN RELIANCE ON ANY MISSTATEMENT MADE ABOVE. I DECLARE, UNDER PENALTY OF PERJURY, ALL OF THE ABOVE INFORMATION TO BE TRUE AND CORRECT, TO THE BEST OF MY KNOWLEDGE.

• APPLICANT_______________________________________________ DATE_________________________