Cypress Garden Online Lease Application

Cypress Garden is an income restricted property.

Date*

Date

Time*

:HourMinutesAM/PM Option

Full Name*

First NameLast Name

Gender*

Race*

Ethnicity*

Former Last Name

*If applicable

Social Security Number*

Drivers License Number*

Drivers License State*

Place of Birth*

Street Address

Street Address Line 2

CityState / Province

Country

Home Phone #

Area CodePhone Number

Cell Phone #*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail*

example@example.com

Rental History*

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Rent Amount per Month*

Move In*

Date

Manager/Contact*

First NameLast Name

Manager/Contact Phone Number*

Area CodePhone Number

Manager/Contact Email*

example@example.com

Former Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Rent Amount per Month*

Move In*

Date

Move Out*

Date

Manager/Contact*

First NameLast Name

Manager/Contact Phone Number*

Area CodePhone Number

Manager/Contact Email*

example@example.com

Reason for Leaving*

I Give Permission to Call the Last Two Places of Residence*

Yes

Current Employer*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Occupation*

Supervisor*

First NameLast Name

Supervisor Phone Number*

Area CodePhone Number

Supervisor Email*

example@example.com

Start Date*

Date

Estimated Annual Income*

Miles to Work*

Former Employer*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Occupation*

Supervisor*

First NameLast Name

Supervisor Phone Number*

Area CodePhone Number

Supervisor Email*

example@example.com

Start Date*

Date

End Date*

Date

Estimated Annual Income*

Reason for Leaving

Name*

First NameLast Name

Relationship*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number*

Area CodePhone Number

Cell Phone Number

Area CodePhone Number

Work Phone Number

Area CodePhone Number

Email*

example@example.com

Allowed Access

In the event of serious illness, death, or other circumstances that would make you unavailable, the emergency contact can remove your property from your unity or the common areas

Do you have a vehicle?*

Vehicle Type

Vehicle Make

Vehicle Model

Vehicle Year

Vehicle Color

License Plate #

License Plate State

Will you be bringing any pets?*

Pet Type

Name

Breed

Color

Size (lbs.)

Total Number of People in Household*

Unit Size*

Additional Adult Residents*

Number of Children and Ages*

Gross Salary*

Have you ever been evicted or left owing money to a current or previous Landlord?*

YesNo

Wage for Employment #1 $ blanks* # of Hours per week blank* Amount per year $blank*

Wage for Employment #2 $blanks* # of Hours per week blank* Amount per year $blank*

Child Support/Alimony - Amount per week or month $blanks* Amount per year $blank*

Social Security - Amount per month $blanks* Amount per year $blank*

Public Assistance - Amount per month $blanks* Amount per year $blank*

Pension/Annuity - Amount per month $blanks* Amount per year $blank*

Other Income - Amount per month $blanks* Amount per year $blank*

TOTAL ESTIMATED YEARLY HOUSEHOLD INCOME*

Photocopy of Driver's License for all Adult Members of Household

Browse Files

Photocopy of Social Security Card for all Adult Members of Household

Browse Files

Photocopy of Last Four (4) Paystubs or If Self-Employed, Last Two (2) Month's Bank Statements

Browse Files

Any other applicable documentation

Browse Files

Comments on any income information entered above.

The above information is true and accurate to the best of my knowledge. I do realize that it is my responsibility to notify the staff if there are any changes to theabove information. I also understand that a credit and criminal background report will be completed on me during the application process.

How did you hear about us?*

Name*

First NameLast NameSuffix

Confirm*

I Agree

PENALTIES FOR MISUSING THIS CONSENT:
Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making false or fraudulent statements to any department of the United States Government. HUD and any owner (or any employee of HUD or the owner) may be subject to penalties for unauthorized disclosures or improper uses of information collected based on the consent form. Use of the information collected based on this verification form is restricted to the purposes cited above. Any person who knowingly or willingly requests, obtains, or discloses any information under false pretenses concerning an applicant or participant may be subject to a misdemeanor and fined not more than $5,000. Any applicant or participant affected by negligent disclosure of information may bring civil action for damages and seek other relief, as may be appropriate, against the officer or employee of HUD or the owner responsible for the unauthorized disclosure or improper use. Penalty provisions for misusing the social security number are contained in the Social Security Act at **208 (a) (6), (7) and (8). ** Violations of these provisions are cited as violations of 42 USC **408 (a) (6), (7) and (8). **

NDC Asset Management, LLC. does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs and activities.

CYPRESS GARDEN - SHORT FORM LEASING APPLICATION

PLEASE SUBMIT ONE FORM PER ADULT HOUSEHOLD MEMBER

Rental History

Employment

Emergency Contact

Vehicles & Pets

Household Information

HOUSEHOLD INCOME