SECTION 1
Applicant Information
First Name
Middle Name
Last Name
Date of Birth
Social Security #
Driver's License #
Other Names Used in Last 10 Years
Home Phone
Cell Phone
Email Address
SECTION 2
Additional Occupants
Name
Date of Birth
Relationship to Applicant
Name
Date of Birth
Relationship to Applicant
Name
Date of Birth
Relationship to Applicant
Employer (Current)
Employer (Prior)
Address (Current)
Address (Prior)
Employer Phone (Current)
Employer Phone (Prior)
Job Title (Current)
Job Title (Prior)
Supervisor Name (Current)
Supervisor Name (Prior)
Dates of Employment (Current)
Dates of Employment (Prior)
Income Per Month (Current)
Income Per Month (Prior)
SECTION 4
Residence History
Street Address (Current)
Street Address (Previous 1)
Street Address (Previous 2)
City, State & Zip (Current)
City, State & Zip (Previous 1)
City, State & Zip (Previous 2)
Dates of Stay (Current)
Dates of Stay (Previous 1)
Dates of Stay (Previous 2)
Owner/Manager Name & Phone (Current)
Owner/Manager Name & Phone (Previous 1)
Owner/Manager Name & Phone (Previous 2)
Reason for Leaving (Current)
Reason for Leaving (Previous 1)
Reason for Leaving (Previous 2)
Last Rent Paid (Current)
Last Rent Paid (Previous 1)
Last Rent Paid (Previous 2)
Make (Auto)
Model (Auto)
Color (Auto)
Year (Auto)
License No. (Auto)
Make (Moto)
Model (Moto)
Color (Moto)
Year (Moto)
License No. (Moto)
SECTION 6
Personal References
Name (Emergency Contact)
Name (Close Friend)
Name (Nearest Relative)
Address/City (Emergency Contact)
Address/City (Close Friend)
Address/City (Nearest Relative)
Phone (Emergency Contact)
Phone (Close Friend)
Phone (Nearest Relative)
Relationship (Emergency Contact)
Relationship (Close Friend)
Relationship (Nearest Relative)
SECTION 7
Credit Information
Bank/Savings Name & Branch (Checking)
Account No. (Checking)
Balance (Checking)
Bank/Savings Name & Branch (Savings)
Account No. (Savings)
Balance (Savings)
Account No. (Account 1)
Address/City (Account 1)
Phone (Account 1)
Balance (Account 1)
Due Monthly (Account 1)
Account No. (Account 2)
Address/City (Account 2)
Phone (Account 2)
Balance (Account 2)
Due Monthly (Account 2)
Account No. (Account 3)
Address/City (Account 3)
Phone (Account 3)
Balance (Account 3)
Due Monthly (Account 3)
SECTION 8
General Information
Have you ever filed for bankruptcy?
Do you own any musical instruments?
Do you have any water-filled furniture?
Have you ever been convicted of a crime?
Have you ever been evicted?
Please Explain Any Yes Answers
Why Are You Leaving Your Current Residence?
SECTION 9
Application & Signature
Apartment # Applying For
Monthly Rent
Application Fee
By submitting this application, applicant certifies that all information provided is true and correct, and authorizes Maj West Investments and its agents to verify this information, including but not limited to employment, income, rental history, and a consumer credit report, for the purpose of evaluating this application for tenancy. Submission of this application does not guarantee approval or the reservation of any unit.
Full Legal Name (Typed Signature)
Date
Submit Application
