Basic Information:

First Name*:		Last Name*:
Birth Date*: (mm/dd/yy)		Email Address*:
Home Phone*:		Mobile Phone:

Residency Information (past two years):

Current Street Address*:
Current City*:		Current State*:	Alabama Alaska Arizona Arkansas California Colorado Connecticut 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
Current Zipcode*:		Move-in Date*: (mm/yy)
If you rent, do you make your payments to a management company?			Yes No

Past Residency (if you have lived in more than one location in the past two years):

Street Address:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut 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
Zipcode:		Specific Dates of Occupancy: (mm/yy)	to
Rent or Own?	Rent Own	Monthly Payment:	$

Employment History (past two years):

Current Employer*:		Start Date*: (mm/yy)
Employer Street Address*:		Employer City*:
Employer State*:	Alabama Alaska Arizona Arkansas California Colorado Connecticut 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	Employer Zipcode*:
Employer Phone*:		Your Position*:
Salary*:		Bonus/Overtime*:
Are you paid by W-2, 1099, or are you self- employed?*			W-2 1099 Self-Employed

Past employment (if you have had your current job for less than two years):

Employer:		Dates Worked: (mm/yy)	to
Employer Street Address:
Employer City:		Employer State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut 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
Employer Zipcode:		Employer Phone:
Your Position:
Salary:		Bonus/Overtime:

Real Estate & Liquid Assets -
Please provide list of asset accounts (i.e., checking, savings, money market, etc.):

Do you own a home or other property?*		Yes No
Type of Account*:		Bank/Institution Name*:
Amount in Account*:
Type of Account:		Bank/Institution Name:
Amount in Account:
Type of Account:		Bank/Institution Name:
Amount in Account:

Retirement -
Please list any 401k, 403b, or other such accounts (please do not include pension plans):

Bank/Institution Name:		Amount in Account:
Bank/Institution Name:		Amount in Account: