You must put something in each field.

401 E. Springfield Ave. ^. Champaign, Il 61820 ^. 217-351-1800

rental application

Date:        Phone:  (Home)          (Work)         (Cell)

address applying for       date to move in  

furnished          unfurnished            1st floor            2nd floor             3rd floor    name      birth date      

ss#            dl#                state      

e-mail address         

marital status:    Single Married Divorced Widowed    smoker  nonsmoker  

current address   legal address           

landlords name/Mortgage Co.  

landlords phone #      landlords address 

present rent $    date moved in       lease expires 

bank                  branch         city  

checking acct#            savings acct #   

employer              phone#

employer address                           city  

position     date started  hours per week 

salary                per                  seasonal  permanent   temporary 

supervisors name              dept.  

Have you ever (Yes or No)

                        Had a residence application denied by a landlord                 Been evicted or asked to move out

                       Broken a lease contract or rental agreement                        Filed for bankruptcy

I (we) certify that all information herein is true and complete and give authorization for a

credit check, employment to be verified and prior landlords to be contacted.

False information given shall entitle owner to 1) reject the application, 2) retain the application deposit and

 3) terminate the resident's right to occupancy.

typed name or electronic signature below and/ or transmittal of this completed form serves as acceptance of all terms and grants permission for all verifications to be performed. co-signer(s) and applicant(s) agree that original document with original signatures

will be sent (via usps, ups, or other) to management company within 24 hours of transmittal of this form. failure to do so may result in property being leased to others or forfeiture of deposit.

 applicant's signature                                                                          date       

this application will not be processed until completed in full, signed, and accompanied with a full deposit.

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