APPLICATION

APPLICATION
Official Use Only
Date Received

MonthDayYear
Move In Date

MonthDayYear
APPLICANT INFORMATION
Please choose a community*
First Name*
Middle*
Last*
MaleFemaleN/A
Second Applicant's Name
Each applicant must complete a separate application
Current Address*

Address

Street Address Line 2

CityState

Zip)
Previous Address*

Address

Street Address Line 2

CityState

Zip)
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*

MonthDayYear
Marital Status

MarriedSingleWidowDivorced
Social Security Number*
Drivers License Number
Present Landlord
Phone
Length of Residence
Have you ever lived at another Crestwood Village or Justus Rental Property?

YesNo
Have you ever been evicted from another apartment or senior living community?

YesNo
Have you been convicted of a Felony?

YesNo
Type/Make/Model of Automobile
License Plate #
Do you Smoke?

YesNo
Do you have a cat?

YesNo
Do you have a Dog?

YesNo
Dog's Height (from shoulder to floor)
Inches
How did you learn about Crestwood Village?*

TVDrove ByWebsiteNewspaperSeniors Guide MagazinePostcard/Direct MailResident ReferralProfessional ReferralOther
Professional Referrer*
Who referrered you to us?
FINANCIAL INFORMATION
Monthly Earnings (including Social Security or any other sources of income) *
Occupation/Job Title
Please type retired if no longer working.
Are you a

VeteranSpouse of a Veteran
Appointment
EMERGENCY CONTACT 1
Name*
Relationship*
POA?*

YesNo
Guardian?*

YesNo
Healthcare Representative?*

YesNo
Home Phone*
Cell Phone*
Other
Address*
Email*
example@example.com
EMERGENCY CONTACT 2
Name
Relationship
POA?

YesNo
Guardian?

YesNo
Healthcare Representative?

YesNo
Home Phone
Cell Phone
Other
Address
Email
example@example.com
RESIDENT CONFIRMATION
Crestwood Village's ability to meet the needs of the applicant is determined by a review of the application materials. This information is used to approve move-ins and determine personal needs. Applicant hereby grants permission to secure a credit history and background check. I make this application for admission to Crestwood Village of my own free will and accord, with knowledge that I may change my mind. I declare my answers to be true and complete.
Applicant Signature

Clear
Date

MonthDayYear
Date
Leasing Counselor

Clear
Date

MonthDayYear
Date
Promotion/Special/Concessions
A NON-REFUNDABLE APPLICATION FEE OF $50 PER PERSON and a HOLD DEPOSIT OF $100 PER APARTMENT shall accompany this application. The Hold Deposit is refundable within a 72-hour consideration period or if the applicant is rejected. An applicant that has been placed on the VIP list may remain on the VIP list for up to one year. After one year, the applicant must pay an additional application fee. If application is approved and tenancy taken, this Hold Deposit shall apply on the first month’s rent. Applicant must execute lease immediately upon receipt thereof or reject it 2 weeks prior to occupancy. Failure to do so requires the applicant to place additional application fee and hold deposit to be placed on VIP list.
Furthermore, if applicant does not occupy the apartment as requested, the entire cost for any special work completed by the applicant’s order shall be responsibility of the applicant. Applicant hereby grants permission to verify any information contained herein. Lessor agrees to accept or reject this application within 72 hours from the date received.

SEPARATE PAYMENT FOR APPLICATION FEE AND HOLD DEPOSIT ARE REQUIRED.

MAKE CHECKS OR MONEY ORDERS PAYABLE TO CRESTWOOD VILLAGE.

Visa, MasterCard and Discover are accepted during regular business hours. A non-refundable 2% surcharge will be applied all credit card transactions.
Should be Empty:

APPLICATION

Official Use Only

APPLICANT INFORMATION

FINANCIAL INFORMATION

EMERGENCY CONTACT 1

EMERGENCY CONTACT 2

RESIDENT CONFIRMATION