Personal Information
Address Applying For
- None - Prairie Ridge Seminole Valley
Number of Bedrooms
- None - One Two
Unit #
First Name *
Last Name *
Phone Number *
Work Number
Email Address *
Social Security Number *
Drivers License Number *
Names of Other Adult Occupants
First Name
Last Name
First Name
Last Name
First Name
Last Name
Names of Other Occupants Under the Age of 18
First Name
Last Name
Age
First Name
Last Name
Age
First Name
Last Name
Age
First Name
Last Name
First Name
Last Name
Type of Pet
Weight of Pet
Age of Pet
Type of Pet
Weight of Pet
Age of Pet
Emergency Contact Information
First Name *
Last Name *
Relationship
Address *
City *
State *
- Select - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code *
Phone Number *
Employer *
Other Questions
Residence History
Please provide address history for the last 2 years minimum. Include complete addresses with city names and zip codes. Also include Landlord name(s) or Mortgage Company if you owned your home.
Current Address:
Address Line 1 *
City *
State *
- Select - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code *
Rent/Mortgage *
$ /month
Landlord or Mortgage Company Name *
Landlord or Mortgage Company Phone Number *
Previous Address:
Address Line 1
Address Line 2
City
State
- None - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Rent/Mortgage
$ /month
Landlord or Mortgage Company Name
Landlord or Mortgage Company Phone Number
Previous Address:
Address Line 1
Address Line 2
City
State
- None - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Rent/Mortgage
$ /month
Landlord or Mortgage Company Name
Landlord or Mortgage Company Phone Number
Employment Information:
Current Employer
Employer Address
Employer City
Employer State
- None - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Employer Zip Code
Employer's Phone
Position Held
Income
$
Per
- None - Hour Month Year
Job Type
- None - Permanent Temporary Other
Job Status
- None - Full-Time Part-Time Self-Employed
Current or Previous Employer
Employer Address
Employer City
Employer State
- None - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Employer Zip Code
Employer's Phone
Position Held
Income
$
Per
- None - Hour Month Year
Job Type
- None - Permanent Temporary Other
Job Status
- None - Full-Time Part-Time Self-Employed
Other Income
Please list here if you have any other income you would like us to consider:
Income
$
You are not required to reveal alimony or child support or spouse's annual income unless you want it to be considered
Vehicle Information
First Vehicle
Vehicle Make
Vehicle Model
Vehicle Color
License Plate
State
- None - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Second Vehicle
Vehicle Make
Vehicle Model
Vehicle Color
License Plate
State
- None - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Signature Clause
The purpose of this application is to determine whether I qualify as a tenant. The Landlord and I have no rental agreement until the time that the lease or written rental agreement is signed. My signature below certifies that the above information is correct. I confirm that all information stated above is accurate and that incomplete or falsified information will be subject to rejection and/or prosecution. I authorize the Owner or his manager to investigate my credit and financial responsibility, income, rental and eviction history, conviction record, and the statements made in this application, and to obtain a consumer credit report regarding my credit history from a consumer-reporting agency that complies and maintains files on consumers on a nationwide basis. This will show as an inquiry on your credit file as Apartment Association of South Central Wisconsin. My performance under any such lease or rental agreement that I may enter into with the landlord may be reported to such reporting agency. I acknowledge that the Manager and the agents and employees thereof represent the interests of the Landlord, but they also have a duty to treat all parties fairly and in accordance with fair housing law, and to disclose material adverse facts about the property. I warrant and represent that I am at least 18 years of age and that all information and answers to the above questions are true and complete to the best of my knowledge. I understand that providing false information or making false statements may be grounds for denial of my application. I also understand that such an action may result in criminal penalties. I understand that my occupancy is contingent on meeting management’s resident selection criteria. Once application is approved, deposit paid, and apartment taken off the market, deposit money will not be refunded until lease term has been fulfilled and damages assessed.
Applicant's Signature *
