RENTAL APPLICATION
NAME: ___________________________ STUDENT STATUS: _____Freshman
PRESENT ADDRESS: ___________________________ _____Sophomore
Street
_____Junior
___________________________ _____Senior
City/Town (Zip Code)
_____Graduate
___________________________ Major: ____________________
Present Phone Number
Current Local Landlord/phone:______________________________________________
Previous Landlord/phone:___________________________________________________
EMPLOYER:_______________________________________ Monthly income: $_________
Other sources of income: List employers, grants, parents, loans, etc.
_______________________________________________ Monthly income: $_________
PARENTS' NAMES:________________________________ _________________________
Your Social Security #
(Person to ________________________________ _________________________
contact in Street Drivers License #
case of
emergency) ________________________________ _________________________
City/Town (Zip Code) Date of Birth
________________________________ _________________________
Phone Number Parents' occupations
_________________________
(cont.)
The undersigned states that he or she has never been sued, given a 5-day
eviction notice, or been charged with any crime unless noted on the back
of this application.
I, the undersigned, represented that the data given is true and complete
and authorize verification of this and any other pertinent information. If
it is learned at any time that false information was given, the lease may
be terminated at lessor's option and C will move out on 10 days' notice
and will forfeit any rents and deposits.
I hereby authorize Dickson Rentals to receive and transmit any credit
or behavioral information.
_____________________________________
Signature