PotsdamLiving.com - Application Form

Application Form

Rental Application Form

Instructions:

Complete application in its entirety. Do not leave any sections item blank. For items that do not apply, write ‘N/A’. Incomplete applications will not be accepted.
A Credit Report will be performed and requires a non-refundable fee of $15.00, to be paid in advance and upon submitting Rental Application. You will be contacted to arrange payment and will receive a receipt.
You may also print out and mail or fax your application: print version (pdf)
Required fields are indicated by " * "

Personal Data
Name *		Social Security No. *
Date of Birth *
Drivers License No.		Foreign Residents Visa No.
State of Issuance		Date of Expiration
Date of Expiration

Permanent Address *
		Email Address * Home Phone * Work Phone * Cell Phone * Alt Email

Present Address
		Landlord or Agent Landlord or Agent Phone
How long at present address
Current Rent Rent Paid Through
Current Lease Expires

Previous Address
		Landlord or Agent Landlord or Agent Phone
How long at previous address

Number of Co-Tenants you plan to live with
Name of Co-Tenant(s) to live with you Relationship(s) to you
Name of Co-Tenant(s) to live with you Relationship(s) to you

Pets? If Yes, what kind? How many?

Automobile Make Model
	Year Color State/License No.

How did you hear about us? * Referred by:
What date are you looking to move in?
How long to you plan to rent from us?
Is there a specific unit you desire?
If ‘No’, what type of unit are you looking for?

Occupation
	Present Occupation	Prior Occupation
Occupation
Employer
Self-employed, doing business as
Business Address
Business Phone
Type of Business
Position held
Name and Title of Supervisor
How long Supervised by this person
Monthly Gross Income
*If employed or self-employed less than two years, give same information on prior occupation.

Student Information
Are you a student?
Name of school attending Expected year of graduation
Explain how you plan to pay your rent if not employed

References (Provide at least two non-related individuals that can be contacted to verify your qualifications)
Name Address Phone
Occupation Length of Acquantance (Yrs / Mos)

Name Address Phone
Occupation Length of Acquantance (Yrs / Mos)

Name Address Phone
Occupation Length of Acquantance (Yrs / Mos)

Nearest Relative
Name Address Phone
Occupation Relationship

Name Address Phone
Occupation Relationship

Name Address Phone
Occupation Relationship

Other Information
Provide the total amount of expenses paid to creditors per month (e.g. car payment, rent, utilities, alimony, student loans, child care, etc.)
Have you ever filed a petition for bankruptcy?
Have you ever been asked to leave any tenancy?
Have you ever been evicted from any tenancy?
If ‘Yes’ to questions 2 or 3, why?
Have you ever willfully and intentionally refused to pay any rent when due?
If ‘Yes’, why?

	* I DECLARE THAT I HAVE READ, UNDERSTAND, AND AGREE TO THE RENTAL POLICY. To read the Rental Policy click here.
	* I DECLARE THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT, AUTHORIZE ITS VERIFICATION AND THE OBTAINING OF CONSUMER CREDIT REPORT. I agree that Landlord may terminate any agreement entered into in reliance on any misstatement made above.
Verification: Please enter the exact text from the image provided in the space above.