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Culp's Apartments

Rental Application

Please fill out the following application form as completely and accurately as possible.
Application fee is $40.00, payable online, via mail, or in person.
Rental application is also available in PDF format.

Please tell us about yourself

Full Name:
	^First ^MI ^Last
Date of Birth:
Social Security #:
Email Address:
Telephone:
Other phone:

Co-applicant Name:
	^First ^MI ^Last
Co-applicant DOB:
Social Security #:
Dependents:



	^First ^Last ^{Year of Birth}

Please give residential history (last three years)

Current Address:
	^{Street Address}	^City	^State	^Zip

Month/Year Moved In:	Monthly Rent:	$
Owner/Agent:	Owner's Telephone:
Reasons for Leaving:

Previous Address:
	^{Street Address}	^City	^State	^Zip

Month/Year Moved In:

Month/Year Moved Out:

Monthly Rent:

Owner/Agent:

Owner's Telephone:

Previous Address:
	^{Street Address}	^City	^State	^Zip

Month/Year Moved In:

Month/Year Moved Out:

Monthly Rent:

Owner/Agent:

Owner's Telephone:

Previous Address:
	^{Street Address}	^City	^State	^Zip

Month/Year Moved In:

Month/Year Moved Out:

Monthly Rent:

Owner/Agent:

Owner's Telephone:

Please describe your credit history

Have you declared bankruptcy in the past seven (7) years?
Have you ever been evicted from a rental residence?
Have you had two or more late rental payments in the last year?
Have you ever willfully or intentionally refused to pay rent when due?
Please explain any Yes responses:

Please provide your employment information

Your status:		Employer:
Dates employed:		Position:
Supervisor:		Telephone:
Salary:	$ per
If employed by above less than 12 months, give name & phone of previous employer or school


If you have other sources of income that you would like us to consider, please list income, source, and person (banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application.
Amount: $ Source:		Contact Info:
Amount: $ Source:		Contact Info:
Amount: $ Source:		Contact Info:

Please list your references and vehicles

Non-family References:
Name:			Relationship:
Telephone:			Address:
Name:			Relationship:
Telephone:			Address:
Name:			Relationship:
Telephone:			Address:

Emergency Contact:
Name:			Relationship:
Telephone:			Address:

Driver's Licence:
Your Driver's Licence Number:			State:

Vehicle Information:

Make & Model:			Year:			License Plate:			State:
Make & Model:			Year:			License Plate:			State:

Additional Information

Please give any additional information that might help owner/management evaluate this application:

Where may we reach you to discuss this application?
Day Telephone:			Night Telephone:

I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and agree that the rental is to be payable the first day of each month in advance. As an inducement to the owner of the property and to the agent to accept this application, I warrant that all statements above set forth are true; however, should any statement made above be a misrepresentation or not a true statement of facts, all of the deposit will be retained to offset the agent's cost, time, and effort in processing my application.

I recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained through personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics, and mode of living.

The above information, to the best of my knowledge, is true and correct.

I Agree

I Disagree

AUTHORIZATION: Release of Information

I agree to permit an investigation of my credit, tenant history, background, and employment for the purposes of renting an apartment with this owner/manager.

I Agree

I Disagree