Leasing Application

Applicant's Personal Information
Name*
First Last
Home Phone*
Alternative Phone*
Email Address*
Date of Birth*
MM
DD
YYYY
Details of Employment
Employer*
Position*
Date Hired*
MM
DD
YYYY
Supervisor's Name*
Phone*
Salary*
Indicate if salary is weekly, monthly, etc
Prior Employer (if employed less than 1 year at current job)*
Prior Position
Date Hired
MM
DD
YYYY
Last Day
MM
DD
YYYY
Supervisor's Name
Reason for Leaving
Residential History
Present Street Address*
Street Address City State / Province / Region ZIP / Postal Code Country
How long at this address?*
Landlord's Name*
Landlord's Phone Number*
Criminal Background History
Have you ever been convicted of a felony?*
- Yes
- No
If yes, please explain:*
Banking Information
Banking Institution Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*

Second Applicant's Personal Information
Second Applicant's Name
First Last
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
Alternative Phone
Email Address
Date of Birth
MM
DD
YYYY
Second Applicant's Employment Details
Employer
Position
Date Hired
MM
DD
YYYY
Supervisor's Name
Phone
Salary
Indicate if salary is weekly, monthly, etc
If employed less than a year, previous employer's name:
Position
Date Hired
MM
DD
YYYY
Last Day
MM
DD
YYYY
Supervisor's Name
Reason for Leaving
Second Applicant's Residential History
Present Street Address
Street Address City State / Province / Region ZIP / Postal Code Country
How long at this address?
Landlord's Name
Phone
Second Applicant's Additional Sources of Income
Does the second applicant have any additional sources of income?
- Yes
- No
Please provide a contact person who can verify the additional income as well as their phone number.
Second Applicant's Criminal History
Has the second applicant been convicted of a felony?
- Yes
- No
If yes, please explain:

References
Reference #1 Name and Phone*
Reference #2 Name and Phone
Emergency Contact Information
Name*
First Last
Relationship
Phone*
Leasing Application Agreement*
Yes I agree
I declare that the information I have provided is accurate. I authorize the individual or organization to whom this application is submitted to: (a) contact my references and all the other persons that I have named in this application: and (b) perform a credit and/or criminal check to assess my suitability as a tenant/lessee.
Applicant #1*
Applicant #2 Signature
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

935 Paris Rd.
Mayfield, KY 42066



PO 447
Mayfield, KY 42066



270.247.2734

Applicant's Personal Information