Name of Applicant: ___________________________________________

    Address: ___________________________________________

    Telephone #: ___________________________________________

Place of Employment:  ___________________________________________

    Address: ___________________________________________

    Telephone #: ___________________________________________

Salary Range: 10,000-20,000_____ 21,000-30,000_____31,000-40,000_____  Over 41,000_____.

Next of Kin: ___________________________________________

Relationship to Applicant: ___________________________________________

   Address:  ___________________________________________

   Telephone #: ___________________________________________

References: ___________________________________________

Present Landlord: ___________________________________________

   Address: ___________________________________________

   Telephone #: ___________________________________________

Previous Landlord: ___________________________________________

   Address: ___________________________________________

   Telephone #: ___________________________________________

Other References and Telephone #s. ___________________________________________
 

I certify by my signature that all of the above information is correct: ___________________________________________

*YOU MUST PROVIDE A COPY OF A RECENT (30 DAY) CREDIT REPORT FOR APPROVAL OF THIS APPLICATION*