| APPLICANT |
Name (Last, First, MI, Suffix)
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Social Security #
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Date of Birth
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Home Phone #
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Present Address (Street)
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Address (City, State, Zip)
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How Long?
|
Present Landlord (Name)
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Address (City, State, Zip)
|
Phone #
|
Previous Address (Street)
|
Address (City, State, Zip)
|
How Long?
|
Present Employer (Company Name, Address)
|
Occupation
|
Salary
|
How Long?
|
Phone #
|
Previous Employer (Company Name, Address)
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Occupation
|
Salary
|
How Long?
|
Phone #
|
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| MOTOR VEHICLE INFORMATION (include motorcycle) & DRIVER IDENTIFICATION |
Auto Year, Make, Model, Color
|
License Plate #
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State
|
Driver License #
|
State
|
Auto Year, Make, Model, Color
|
License Plate #
|
State
|
Driver License #
|
State
|
Auto Year, Make, Model, Color
|
License Plate #
|
State
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Driver License #
|
State
|
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| OCCUPANT INFORMATION |
Name of Adult
|
Name of Adult
|
Name of Adult
|
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| REFERENCES |
Personal Reference (Name, Address)
|
Telephone
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Relationship
|
In Case of Emergency (Name, Address)
|
Telephone
|
Relationship
|
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| ADDITIONAL INFORMATION |
| Waterbed? Yes No |
Smokers? Yes No |
Pets? Yes No
Type |
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Reason for Moving?
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Have you ever been evicted from a rent residence? Yes No
If yes, why? |
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| Military Service? Yes No |
Commanding Officer
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Telephone
|
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Have you ever willfully and intentionally refused to pay rent when due? Yes No
If yes, please explain.
|
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Have you ever been convicted of a crime? Yes No
If yes, what, where and when?
|
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| I hereby authorize The Cheney Companies and authorized agents permission to check any portion of this application and/or any other background, credit or personal references. |
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| By submitting this application to the Cheney Companies electronically via internet, I hereby grant the Cheney Companies permission to access my credit information, criminal records and to fulfill utility requirements. Additionally, I authorize them to process the $40 application fee to process my application on the following credit card.
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Pursuant to Chapter 351A of the Revised Statutes Annotated of the State of New Hampshire, the management shall not refuse to rent an apartment to any person because of age, sex, race, color, marital status, physical or mental handicap, religion or national origin, nor shall management discriminate in the terms offered or services rendered.
This information may be used for credit inquiries and to fulfill utility company requirements. The undersigned warrants and Represents that the above statement are true. If it is determined that false information has been given, this application will be denied. |
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