Application for a Shared Co-Living Room
Applicant Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you smoke?
*
Yes
No
Are you a Convicted Felon?
*
Yes
No
Have you ever been Evicted?
*
Yes
No
Emergency Contact
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Current landlord Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Reference
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Notes
Proof of Employment/Income
Employment/Income Proof
Browse Files
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Choose a file
Veteran Income Letter (Letter must be from VA)
Cancel
of
Move-in Cost/ Payment Method
Are you able to pay 1/2 rent deposit rent upfront, if application is accepted?
*
Yes
No
Other
Are you able to pay a one-time, non-refundable, move-in/move-out/key set-up fee of $25?
*
Yes
No
Other
What Payment Method do you plan to use?
*
Banking Debit Card
Direct Express Card
Will you be able to stay for at least 6 months?
*
Yes
No
Other
Submit
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