Number of Dependents

Ages

Current Rental Amt.

$

Current Address  *required				City  *required
State  *required		Zip  *required		Phone #

How Long?

Reason for leaving

Landlord/Owner Name

Phone #

Previous Address				City
State		Zip		How Long?

Landlord/Owner Name

Phone #

Reason for leaving

Other Sources of Income

Amonts

Name of Bank

Account #

Copy of Current Photo ID Attached?

Proof of Income Attached?

App Fee Attached?

How did you find out about the property?

Are you working with a Realtor outside of this office? (Y/N)

If yes, who?

Do you plan to keep pets at this property? (Y/N)

If yes, what breed?

Have you ever filed for Bankruptcy? (Y/N)

If yes, when?

Have you ever been Evicted from tenancy? (Y/N)

If yes, when?

Have you ever willfully or intentionally refused to pay rent when due? (Y/N)

Nearest Relative NOT living with you

Relationship

Address

Phone #

Applicant understands that any false statements made on this application may void any lease entered into based on the above information. I hereby authorize the release of the above information. I also authorize Grass Valley Properties Management Division of Palisades Property Realty, to run a credit check on me in the future at their own expense in their efforts to collect any moneys owed by me to them.