VGM Apartment Application Form
Today's Date
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Month
-
Day
Year
Date
Area Applied For
Bethalto Illinois Apartments
Carrolton Illinois Apartments
Bethalto Apartments
Coachlight Apartments
Kansas Apartments
Meadowbrook Apartments
Moro Apartments
Moro Apartments II
Applicant's Name
First Name
Middle Name
Last Name
Birth Date:
-
Month
-
Day
Year
Date
Driver's License #:
Attach a copy of your driver's license
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Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How Long? (Months)
Monthly Rent
Reason for Moving:
Mobile Number
Landline
E-mail
example@example.com
Emergency Contact Person
Emergency Contact Number
Employer Info:
Employer's Name
Employer's Phone Number
Please enter a valid phone number.
Employer's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Start Date
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Month
-
Day
Year
Date
Gross Monthly Income (Note: Proof of income is required)
Cotenant Information
Relationship of every person to live with you (even temporary): (spouse, significant other, dependent, friend, sibling, caretaker)
Tenant 1
First Name
Last Name
Date of Birth (tenant 1)
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Month
-
Day
Year
Date
Relationship to tenant 1
Tenant 2
First Name
Last Name
Date of Birth (tenant 2)
-
Month
-
Day
Year
Date
Relationship to tenant 2
Tenant 3
First Name
Last Name
Date of Birth (tenant 3)
-
Month
-
Day
Year
Date
Relationship to tenant 3
Personal References
Personal Reference 1
First Name
Last Name
Phone Number of Reference 1
Please enter a valid phone number.
Date of Birth (reference 1)
-
Month
-
Day
Year
Date
Relationship to reference 1
Personal Reference 2
First Name
Last Name
Phone Number of Reference 2
Please enter a valid phone number.
Date of Birth (reference 2)
-
Month
-
Day
Year
Date
Relationship to reference 2
Vehicle Make / Model / Plate #
Have you been convicted of a violation of a Local, City, County, State or Federal Ordinance or Law
Please Select
Yes
No
Have you ever received a “Demand to Pay Rent or Quit” (5 Day Notice) from a Landlord?
Please Select
Yes
No
Do you need special accommodations or modifications to the living unit based on a disability?
Please Select
Yes
No
The information solicited on this application is requested by the apartment owner in order to assure the Federal Government, acting throughUSDA Rural Development, that Federal Laws prohibiting discrimination against tenant applicants on the basis of race, color, national origin,religion, sex, marital status, age, and handicap are complied with. You are not required to furnish this information, but are encouraged to doso. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not toFurnish it; the owner (or managing agent) is required to note the race, ethnicity and sex of individual applicants on the basis of visualobservation or surname
Head of Household
(Check as appropriate)
Race
American Indian / Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Marital Status
Married
Separated
Unmarried
Sex
Male
Female
Back
Next
Applicant Screening Verification
Applicant Name
First Name
Middle Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Driver's License #
Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Landlord's Name
First Name
Last Name
Current Landlord's Phone
Please enter a valid phone number.
Current Landlord's Fax
Please enter a valid phone number.
Are you related to the landlord
Yes
No
If Yes, in what way?
Applicant's Prior Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Prior Landlord's Name
First Name
Last Name
Prior Landlord's Phone
Please enter a valid phone number.
Prior Landlord's Fax
Please enter a valid phone number.
Are you related to the landlord
Yes
No
If Yes, in what way?
Authorization
I authorize and request my past and present employers, landlords and references to release any information necessary to VGM Management and/or their agents regarding verification of my application statements as they relate to my qualification for tenancy. I authorize VGM Management and/or their agents to obtain a current credit report and release of criminal history and police contact report. A photocopy of this application showing my signature shall be as valid as the original. This Application once submitted will become the property of VGM Management.
Please tick the checkbox as confirmation your details are correct
*
Yes I confirm all my details are correct
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