| PLEASE RETURN COMPLETED APPLICATIONS TO: Kirk Walters P.O. Box 137 North Liberty, IA 52317 Or fax to (319) 626-4542 |
| *Note: If you have additional information, please use a separate sheet of paper and attach to this form. |
| welcome to: |
| Apartments by Walters |
RENTAL APPLICATION EACH PERSON MUST FILL OUT AN APPLICATION
DESIRED MOVING DATE _________________________________________________________
How you heard of us ____ Newspaper ____ Sign ____ Friend ____ Web _____ Other __________
FULL NAME __________________________________________ BIRTH DATE _______________
PHONE NUMBERS _____________________•_____________________•__________________
home work cell
SOCIAL SECURITY # ______________ DRIVER’S LICENSE # _____________ STATE ______
PEOPLE TO LIVE WITH YOU
1. _________________________________________________________________________
full name relationship age
2. _________________________________________________________________________
full name relationship age
DO YOU HAVE PETS? ______ IF SO, DESCRIBE _____________________________________
DO YOU HAVE A WATER BED? ________ DO YOU SMOKE? _________
DO YOU HAVE RENTER’S INSURANCE? ________ INSURANCE COMPANY ________________
PRESENT ADDRESS ____________________________________________________________
NAME(S) ON LEASE _____________________________________________________________
RENT $ _________ / month FROM ______________________ TO _____________________
REASON FOR MOVING __________________________________________________________
OWNER/MANAGER ________________________________________ PHONE #____________
PREVIOUS ADDRESS ___________________________________________________________
NAME(S) ON LEASE ____________________________________________________________
RENT $ _________ / month FROM _______________________ TO ____________________
REASON FOR MOVING __________________________________________________________
OWNER/MANAGER ___________________________________________ PHONE #__________
PRESENT OCCUPATION __________________________________________________________
EMPLOYER AND LOCATION ____________________________________ PHONE #__________
SUPERVISOR’S NAME _________________________________________ PHONE #__________
DATES WORKED FROM ________________________ TO _____________________________
PREVIOUS OCCUPATION _________________________________________________________
EMPLOYER AND LOCATION ____________________________________ PHONE # _________
SUPERVISOR’S NAME _________________________________________ PHONE # _________
DATES WORKED FROM ________________________ TO _____________________________
CURRENT GROSS INCOME PER MONTH (before deductions) $ ___________________________
OTHER SOURCES OF INCOME $ _________ per _____ OR ASSISTANCE $ ________ per_____
ARE YOU A STUDENT? _______ SCHOOL NAME _____________________________________
LIST SOURCES OF ASSISTANCE __________________________________________________
AMOUNT YOU RECEIVE $ ___________
AMOUNT OF CHILD SUPPORT/ALIMONY YOU PAY $ ____________ RECEIVE $ __________
CHECKING ACCOUNT BANK
_____________________________________________________________________________
name city state
SAVINGS ACCOUNT BANK
_____________________________________________________________________________
name city state
MAJOR CREDIT CARD ___________________ BALANCE OWED _________ PAYMENT_______
CREDIT REFERENCE ___________________________________________________________
HAVE YOU EVER FILED FOR BANKRUPTCY? ______ HAVE YOU EVER BEEN EVICTED? _____
TOTAL NUMBER OF VEHICLE(S) _____________ * NOTE: Only 2 vehicles per apartment allowed.
_____________________________________________________________________________
make model year color license plate # state
_____________________________________________________________________________
make model year color license plate # state
PERSONAL REFERENCE
_____________________________________________________________________________
name phone # address
CONTACT IN EMERGENCY
_____________________________________________________________________________
name phone # address
Have you been or are you presently an illegal user of a controlled substance? ________________
I declare that the above statements are true and correct, and I hereby authorize verification of
given references and a credit check.
X ____________________________________________________________________________
signature date
DESIRED MOVING DATE _________________________________________________________
How you heard of us ____ Newspaper ____ Sign ____ Friend ____ Web _____ Other __________
FULL NAME __________________________________________ BIRTH DATE _______________
PHONE NUMBERS _____________________•_____________________•__________________
home work cell
SOCIAL SECURITY # ______________ DRIVER’S LICENSE # _____________ STATE ______
PEOPLE TO LIVE WITH YOU
1. _________________________________________________________________________
full name relationship age
2. _________________________________________________________________________
full name relationship age
DO YOU HAVE PETS? ______ IF SO, DESCRIBE _____________________________________
DO YOU HAVE A WATER BED? ________ DO YOU SMOKE? _________
DO YOU HAVE RENTER’S INSURANCE? ________ INSURANCE COMPANY ________________
PRESENT ADDRESS ____________________________________________________________
NAME(S) ON LEASE _____________________________________________________________
RENT $ _________ / month FROM ______________________ TO _____________________
REASON FOR MOVING __________________________________________________________
OWNER/MANAGER ________________________________________ PHONE #____________
PREVIOUS ADDRESS ___________________________________________________________
NAME(S) ON LEASE ____________________________________________________________
RENT $ _________ / month FROM _______________________ TO ____________________
REASON FOR MOVING __________________________________________________________
OWNER/MANAGER ___________________________________________ PHONE #__________
PRESENT OCCUPATION __________________________________________________________
EMPLOYER AND LOCATION ____________________________________ PHONE #__________
SUPERVISOR’S NAME _________________________________________ PHONE #__________
DATES WORKED FROM ________________________ TO _____________________________
PREVIOUS OCCUPATION _________________________________________________________
EMPLOYER AND LOCATION ____________________________________ PHONE # _________
SUPERVISOR’S NAME _________________________________________ PHONE # _________
DATES WORKED FROM ________________________ TO _____________________________
CURRENT GROSS INCOME PER MONTH (before deductions) $ ___________________________
OTHER SOURCES OF INCOME $ _________ per _____ OR ASSISTANCE $ ________ per_____
ARE YOU A STUDENT? _______ SCHOOL NAME _____________________________________
LIST SOURCES OF ASSISTANCE __________________________________________________
AMOUNT YOU RECEIVE $ ___________
AMOUNT OF CHILD SUPPORT/ALIMONY YOU PAY $ ____________ RECEIVE $ __________
CHECKING ACCOUNT BANK
_____________________________________________________________________________
name city state
SAVINGS ACCOUNT BANK
_____________________________________________________________________________
name city state
MAJOR CREDIT CARD ___________________ BALANCE OWED _________ PAYMENT_______
CREDIT REFERENCE ___________________________________________________________
HAVE YOU EVER FILED FOR BANKRUPTCY? ______ HAVE YOU EVER BEEN EVICTED? _____
TOTAL NUMBER OF VEHICLE(S) _____________ * NOTE: Only 2 vehicles per apartment allowed.
_____________________________________________________________________________
make model year color license plate # state
_____________________________________________________________________________
make model year color license plate # state
PERSONAL REFERENCE
_____________________________________________________________________________
name phone # address
CONTACT IN EMERGENCY
_____________________________________________________________________________
name phone # address
Have you been or are you presently an illegal user of a controlled substance? ________________
I declare that the above statements are true and correct, and I hereby authorize verification of
given references and a credit check.
X ____________________________________________________________________________
signature date
Apartments for Rent Coralville Iowa
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