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Pomona Apartments

RENTAL APPLICATION
All sections must be completely filled out by each individual.
Each applicant must be 18 years of age or older.
Last Name
 First Name
 Middle Name
 Social Security #
Date of Birth (mm/dd/yyyy)
 Drivers License #
 State
 Cell Phone
 E-Mail Address
Present Address
 City
 State
 Zip
1 Date Moved-In
 Date Moved-Out
 Owner/Manager's Name
 Owner/Manager's Phone
Reason for leaving?
2 Previous Address
Date Moved-In
 Date Moved-Out
 Owner/Manager's Name
 Owner/Manager's Phone
Reason for leaving?
3 Previous Address
Date Moved-In
 Date Moved-Out
 Owner/Manager's Name
 Owner/Manager's Phone
Reason for leaving?
4 Previous Address
Date Moved-In
 Date Moved-Out
 Owner/Manager's Name
 Owner/Manager's Phone
Reason for leaving?

Proposed Occupants (Include all in addition to yourself.) Name Name

Will you have pets?
Yes No 		Describe
 Will you have liquid filled furniture?
Yes No

A Present Employer Name
 Address
How long with employer?
 Phone Number
Name of Supervisor
B Present Employer Name
 Address
How long with employer?
 Phone Number
Name of Supervisor

Current Gross Income $
 Check One
Mo. Wk. Yr. 		Please list your financial obligations

Banking Institution Branch Address Account Number(s)
Checking: 
Savings: 

Name of Creditors Address Phone Payment Amount $

In Case of
Emergency Contact 		Address Phone City Relationship
1.
2.
Personal References Address Phone How Long Occupation
1.
2.

Mother's Maiden Name
Automobile Make
 Model
 Year
Motorcycle Make
 Model
 Year
Have you ever been evicted or asked to move?
Yes No 		Why?

Applicant(s) represent that all the above statements are true and correct and hereby authorizes verification of the above items including, but not limited to, the obtaining of a credit report and agrees to furnish additional credit references upon request.

 I agree/sign    Name:    Date:   

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