Name____________________________________________SSN___________________
Address_________________________________________________________________
City___________________State______Zip code___________Phone________________
Lived there from______to______ Email address _______________________
Reason for leaving________________________________________________________
Current landlord______________________Phone______________
Prior Address__________________________City__________State____Zip code______
From__________to_________Landlord____________________Phone______________
May we check with your current or previous landlord for a reference? _______________
Employer____________________________________________Phone_______________
Address_________________________________________________________________
Amt of time at current job__________ Current monthly salary______________
Supervisor’s name__________________________Phone_______________
May we verify the above information with your employer? ___________________
Name of your Bank__________________________
How did you hear of our apartments? ___friend ___newspaper ___sign ___school
___other: _______________________________ Number of people needing apt._______
Do you authorize us to check your credit? __________
Vehicle Color _______ Model__________________ Plate #____________ State_____

Reference (other than relatives): (e.g. teacher, minister, family friend)
Name_________________________________________Length of time known________
Address_________________________________________________________________
Home Phone_____________________ Work Phone___________________
Relationship____________ Tenant’s Desired move- in date________________

In case of emergency, contact:_______________________________________________
Address_________________________________________________________________
Home Phone_____________________ Work Phone___________________

We currently have a “no pets” policy. Do you understand and agree not to bring or allow your visitors to bring pets on the premises?__________
Do you understand and agree not to smoke or allow visitors to smoke inside this apartment building?______________

I, the undersigned, attest that the above information is true and I understand that any false information contained herein may result in termination of lease agreement.
____________________________________________SEAL ________________
(name) (date)

Please return this form with your security deposit and $25.00 application fee. Office phone: 336 414-2992. Please make checks payable to: Glade Street Properties, LLC.