Application

1. Which property are you applying for? *

Arbor Manor | 1925 Bradford Drive, Tell City, IN 47586
Cedar Manor | 633 W 9th Street, Ferdinand, IN 47532
Promising Properties – Apartments
Village Manor | 125 N Cox Lane, Petersburg, IN 47567

Applicant #1: Name *

First

Last

Applicant #1: Phone Number *

Applicant 1: Email Address

Applicant #1: Birthdate *

Applicant #1: Social Security Number *

Applicant #1: Driver's License State *

Applicant #1: Driver's License Number *

3. Applicant #2: Name

First

Last

Applicant #2: Phone Number

Applicant #2: Email Address

Applicant #2: Birthdate

Applicant #2: Social Security Number

Applicant #2: Driver's License State

Applicant #2: Driver's License Number

Present Address *

How long have you lived there? *

Current Rent per Month *

Current Landlord *

First

Last

Landlord's Phone Number

Is present rent up to date? *

Yes
No

Have you been asked to leave? *

Yes
No

How many occupants will there be? (list name, relationship and birthdate)

Employer 1: *

Employer 1: Dates of Employment *

Employer 2:

Employer 2: Dates of Employment

Income #1 (Amount) *

Income #1 Frequency *

Weekly
Biweekly
Monthly
Yearly

Other Income (Amount)

Other Income Frequency

Weekly
Biweekly
Monthly
Yearly

Relative Reference: Name and relation *

Relative Reference: Address and phone number *

Emergency Contact (Name and Phone Number) *

Has any signer ever been sued for bills? *

Yes
No

Has any signer ever been bankrupt? *

Yes
No

Has any signer ever broken a lease? *

Yes
No

Has any signer ever been sued for eviction? *

Yes
No

Has any signer ever been guilty of a felony? *

Yes
No

Is the total move-in amount available now (rent and deposit)? *

Yes
No

Explain any "Yes" answers below with names and details

By checking this box, the applicant authorizes the owner to contact past and present landlords, employers, creditors, credit bureau, neighbors and any other sources deemed necessary to investigate applicant. *

I Agree

By checking this box, the applicant acknowledges that all the information is true, accurate and complete to the best of applicant's knowledge. Owner reserves the right to disqualify tenant if information is not as represented. *

I Agree

BY TYPING IN FULL LEGAL NAME AND DATE APPLICANT AGREES ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM OR A PHOTOCOPY OF THIS FORM AT ANY TIME *