Address Applying For

Address Applying For:		APT #:
Dates:	To:
Rent: $ /MONTH	Security Deposit: $
Number of People In Group:

Applicant

Applicant Name:	Phone #:
Email Address:

Present Address

Address:	City:
State: Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip:
Dates Rented:	To:
Landlord:	Landlord Phone:

Previous Address

Address:	City:
State: Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip:
Dates Rented:	To:
Landlord:	Landlord Phone:

Cosigner Information (If Necessary)

Name:
Address:	City:
State: Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip:
Relationship to Applicant:	Phone:

Present Employer

Employer:	Phone:
Address:	City:
State: Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip:
How Long Employed:	Monthly Income:

Source of Funds for Rent Payment

Savings: Yes No	Working: Yes No	Parents: Yes No	Financial Aid*: Yes No	Other: Yes No
*List source and amount:

All apartments are rented in "As Is" condition as shown unless specifically stated otherwise on lines 29-34 of lease agreement.

In order for apartment to be held, the security deposit must be paid with the application. If the application is not approved, the security deposit will be refunded. If the application is approved and the applicant later decides not to execute the leave, landlord will attempt to mitigate applicant’s damages. Only after the apartment or house is re-rented will the landlord refund any monies paid, less costs, including future lost rent. Applicant is responsible for all rental payments due under the terms of the contract until the apartment is re-rented.

This application gives authorization for investigation of references listed herein. This application is not a rental agreement, contract or leave. It is subject to approval of owner and managing agent.

It is the policy of Patrick Properties to give no keys to new tenants until the security deposit and rent are paid in full and a signed lease is on file in our office.