________________________________________________________________________ General Information First Name: Last Name: Email Address: Cell Phone: Home Phone: Business Phone: ________________________________________________________________________ Current Residence History Current Address: City: State: Zip Code: How long at current address? Current Rent Payment: Current Landlord: Current Landlord Phone: Reason for Leaving Current Address: If current residence less than two years Previous Address: Previous City: Previous State: Previous Zip: How long at previous address? Previous Rent Amount: Previous Landlord: Previous Landlord Phone: Reason for Leaving Previous Address: ________________________________________________________________________ Current Employment Current Employer: Current Employer Phone: Current Employer Address: Current Employer City: Current Employer State: Current Employer Zip: Current Position: How long with current employer? Current Gross Monthly Income: Current Supervisor: Current Supervisor Phone: Other Income Source: Other Income Amount: Previous Employer: Previous Employer Phone: Previous Employer Address: Previous Employer City: Previous Employer State: Previous Employer Zip: Previous Position: How long at previous address? Previous Gross Monthly Income: Previous Supervisor: Previous Supervisor Phone: ________________________________________________________________________ Do you have bank account(s)? Yes No If yes list bank(s)? Have you ever filed for bankruptcy? Yes No If yes date of discharge? Have you ever broken a lease? Yes No Have you ever been evicted? Yes No Been convicted of felony? Yes No Been sued for non-payment of rent? Yes No Been sued for damage to rental property? Yes No Explain any yes above ________________________________________________________________________ Personal References (no relatives) Persons who have visited your current residence Name Visitor 1: Phone for Visitor 1: Best time to contact Visitor 1: Name Visitor 2: Phone for Visitor 2: Best time to contact Visitor 2: ________________________________________________________________________ In Case of Emergency or Death (pursuant to Title 41 O.S. 130A) notification to be made to: Name Emergency Contact 1: Phone Emergency Contact 1: Relationship of Emergency Conact 1: Name Emergency Contact 2: Phone Emergency Contact 2: Relationship of Emergency Contact 2: ________________________________________________________________________ Co-applicant Information (spouse/roomate) First name co-applicant: Last Name co-applicant: Email for co-applicant: Cell Phone for co-applicant: Address for co-applicant State for co-applicant: City for co-applicant: Zip for co-applicant: How long has co-appliant lived in current residence? Current Rent Amount co-applicant: Current Landlord of co-applicant: Current Landlord Phone for co-applicant: Reason co-applicant leaving current residence: Co-applicant Employment Employer co-applicant: Employer Phone co-applicant: Employer Address co-applicant: How long has co-applicant been employed with this employer? Current Position co-applicant: Current Gross Mo. Income co-applicant: Previous Employer co-applicant: Previous Employer Phone co-applicant: How long has co-applicant worked for previous employer? Previous Position co-applicant: Previous Gross Mo. Income co-applicant: ________________________________________________________________________ Other Income Source for co-applicant: Other Income Amount co-applicant: ________________________________________________________________________ Co-applicant have bank account(s)? Yes No If yes - list bank(s) co-applicant: Has co-applicant filed for bankruptcy? Yes No If yes - date of discharge co-applicant: Has co-applicant broken a lease? Yes No Has co-applicant ever been evicted? Yes No Co-applicant ever convicted of felony? Yes No ________________________________________________________________________ Will there be additional occupants (other than applicants)? Yes No If yes list all additional occupants. Please include name and age: ________________________________________________________________________ Will any smokers occupy the property? Yes No ________________________________________________________________________ Do you have Tenant's Homeowners Insurance Coverage? Yes No If yes - Name of Insurance Company: ________________________________________________________________________ Will any pets live on premises? Yes No If yes- how many? If yes - please list breed weight and age for each: ________________________________________________________________________ List Automobiles - Make Year and License Tag # List any trailers boats motorcycles motor homes or commercial vehicles to be stored on property: Describe water-filled furniture you want to have in the rental property: ________________________________________________________________________ All applications are subject to a $25.00 non-refundable application fee. Payment will be made by: Bank Account Credit Card ___________________________________________________________________________ By placing your initials below you are verifying that all information provided is true and accurate and that you have read and understand both the Lease Acknowledgement and Broker Relationship pages - both of which can be accessed by links below. Your application will not be processed if this information is not read. 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