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Text For Availabilty: 607-759-5311 | Email @ [email protected]

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Client Application

This application and its contents are considered part of the lease. Please fill out all the questions below.

Name(Required)

First Middle Last

Email(Required)

Sex(Required)

Home Phone

Mobile Phone(Required)

Work Phone

SS#(Required)

Driver License #(Required)

State(Required)

DOB(Required)

Marital Status(Required)

Single

Married

Divorced

Widowed

Present Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Present Landlord's Name(Required)

Present Landlord's Phone(Required)

Present Monthly Rent(Required)

Present Reason For Moving(Required)

Previous Rental Address(Required)

Street Address Address Line 2 City State ZIP Code

Previous Landlord's Name(Required)

Previous Landlord's Phone(Required)

Previous Monthly Rent(Required)

Previous Reason For Moving(Required)

Rental Assistance / Subsidy

Voucher Amount

Expiration Date:

Case Number

Case Worker Name

Case Worker Phone

Emergency Contact Name 1(Required)

First Last

Emergency Contact Phone 1(Required)

Emergency Contact City 1(Required)

Emergency Contact State 1(Required)

Emergency Contact Relationship 1

Emergency Contact Name 2(Required)

First Last

Emergency Contact Phone 2(Required)

Emergency Contact City 2(Required)

Emergency Contact State 2(Required)

Emergency Contact Relationship 2(Required)

Present Occupation(Required)

Employer Name(Required)

Employer Phone(Required)

Employer-Human Resources Dept Phone(Required)

Current Income After Deduction(Required)

Current Income Paid(Required)

Weekly

Bi-Weekly

Monthly

Yearly

Filed for bankruptcy?(Required)

Yes

Date Fiiled?(Required)

Been served an eviction notice or been asked two vacate a property you were renting?(Required)

Yes

Evicted When?(Required)

Willfully or intentionally refused to pay rent when due?(Required)

Yes

When was it withheld(Required)

Been used for unlawful detainer?(Required)

Yes

Detainer when?(Required)

Been convicted or committed a felony?(Required)

Yes

When was the felony?(Required)

Been charged or arrested for drug possession or sale?(Required)

Yes

Signature(Required)

Today's Date(Required)

MM slash DD slash YYYY

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