Applicant Information:

Property Name:
Applicant's Full Name:
Phone Number:
Social Security Number:
Date of Birth:
Email Address:
Present Employer:
Employer Phone Number:
Employer Address:
Monthly Income:
Type of Work:
Date Employed:
Supervisor's Name:

Spouse Information:

Spouse's Full Name:
Social Security Number:
Date of Birth:
Present Employer:
Employer Phone Number:
Employer Address:
Monthly Income:
Type of Work:
Date Employed:
Supervisor's Name:

Current Information:

Present Street Address:
City:
State:
Zip:
Name of Property Owner/Apartment Manager:
Phone Number:
Date Current Lease Is Up:

Emergency Contact Information:

Emergency Contact:
Relationship:
Phone Number:

Please Answer & Type Yes or No:

Has Applicant or Spouse Ever Been Evicted:
Ever Broken a Rent Agreement:
Ever Been Sued for Non-Payment or Damages:
Have You Ever Declared Bankruptcy:
Ever Been Convicted of a Felony:
If so, when & describe:
Will this be your primary residence:

Assets/Liabilities:

List Any Assets & their Value, Separated by Commas:
List Any Liabilities & their value, Separated by Commas:

Additional Comments:

The undersigned person(s) hereby certify that all the above statements are true and complete and hereby authorize verification of such information. False information given above shall be grounds for owner’s rejection of this application, no-return of deposit(s) and termination of occupancy. Your signature authorizes Canton Management Company to release your  credit profiles.

Name:
Date: