Personal Information: First Name * Last Name * Email Address Present Address: (City, State, Zip) * Permanent Address: (City, State, Zip) * Cell/Mobile Number: * Home Phone Number: Vehicle Make, Model, Color, License Plate: Rental History: Have you ever rented a house or apartment before: Yes No Present Landlord/Company, Leasing Address, Phone # Previous Landlord/Company, Leasng Address, Phone #: Previous Landlord/Company, Leasng Address, Phone #: Check If Any of These Apply to You: * Yes I have Been Evicted or Asked to Move Out Yes I have Broken a Previous Lease Contract Yes I have Been Delinquent in Payments to a Landlord or Leasing Company None of the Above Apply to Me Current Employer, Supervisor, Phone #: Emergency Contact, Relationship, Phone #: * Do you Own a Pet That Will Live with You In One of Our Properties?: * Yes No Information About Your Pet - Breed, Weight of Dog: How Did You Hear About Campus Cribs? * Friend Web Search Google Advertisement Print Advertisement Radio Advertisement IDS Advertisement Declaration of Truth of Submission: * I declare that the foregoing information is true and correct. I authorize its verification and the obtaining of a credit report. I agree that Landlord may terminate any agreement entered into in reliance on any misstatement made above. Digital Signature: reCAPTCHA To Be Collected During Office Visit (Privacy Sensitive Data): SS#: DOB: Drivers License #:
