Application Form
Today's Date
-
Month
-
Day
Year
Date
Applicant Info
Applicant's Name
First 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
Please enter a valid phone number.
Landline
Please enter a valid phone number.
Email
example@example.com
Emergency Contact Person
First Name
Last Name
Emergency Contact Number
Please enter a valid phone number.
Employer's Name
First Name
Last 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
-
Month
-
Day
Year
Date
Gross Monthly Income
(Note: Proof of income is required)
Tenant 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 Reference 1
First Name
Last Name
Date of Birth (Reference 1)
-
Month
-
Day
Year
Date
Relationship to Reference 1
Personal Reference 2
First Name
Last Name
Date of Birth (Reference 2)
-
Month
-
Day
Year
Date
Relationship to Reference 2
Have you been convicted of a violation of a Local, City, County, State or Federal Ordinance or Law
Yes
No
Have you ever received a “Demand to Pay Rent or Quit” (5 Day Notice) from a Landlord?
Yes
No
Do you need special accommodations or modifications to the living unit based on a disability?
Yes
No
Head of Household
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.
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
Please Select
Single
Married
Divorced
Widowed
Separated
Sex
Please Select
Male
Female
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Applicant Screening Verification
Date
-
Month
-
Day
Year
Date
Applicant Name
First 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
Landlord Name
First Name
Last Name
Landlord Phone Number
Please enter a valid phone number.
Landlord Fax
Please enter a valid phone number.
Are you Related to Landlord
Please Select
Yes
No
If yes, in what way
Applicant's Prior Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Landlord Name
First Name
Last Name
Landlord Phone Number
Please enter a valid phone number.
Landlord Fax
Please enter a valid phone number.
Are you Related to Landlord
Please Select
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.
Signature
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