Primary Applicant Your Name DOB Your Email Address Phone Numbers (Home) (Cell) (Work) Your Current Mailing Address Street Address Apt, Suite, Bldg. (optional) City State / Province / Region Postal / Zip Code Country Co-Applicant Co-applicant Co-applicant DOB Previous Landlord Current Landlord's Name Landlord's Phone # How long at this address Reason for leaving Personal References (List 3) Reference #1 Name Telephone for Reference #1 Email for Reference #1 Relationship to Reference #1 Reference #2 Name Telephone for Reference #2 Email for Reference #2 Relationship to Reference #2 Reference #3 Name Telephone for Reference #3 Email for Reference #3 Relationship to Reference #3 Additional Information Number and type of pets Have either of you ever been party to an eviction? Total number of adults Number and relations of all other applicants By submitting this electronic form I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for tenant screening as may be necessary in arriving at a tenant decision. I understand that the landlord may terminate any rental agreement entered into for any misrepresentation made above. I also understand that a current credit report (within the last 90 days) will be required.