For (address): 229 Winchester Dr, Goleta

Preferred move-in date:

Name:

Phone  Home:

Work:

Social Sec. No.

Date of Birth:    /    /

Driver's Lic. No.

State:

Cosigner’s Name:

Cosigner must fill out separate application

Present Address:

Phone:

From:      /     /

To:      /     /

Reason for moving:

Owner/Manager:

Phone:

Previous Address:

From:      /     /

To:      /     /

Reason for moving:

Owner/Manager:

Phone:

Have you ever been evicted or asked to move? o Yes   o No

E-mail:

Name and relationship of every person to live with you (include ages of minor children)

Describe any pets:

Water bed? o Yes   o No

Smoker? o Yes o No

Present occupation:

Employer:

Phone:

How long?

Supervisor:

Phone:

Previous occupation:

Employer:

Phone:

How long?

Supervisor:

Phone:

Current gross income per month (before deductions) $

Other sources of income:

Bank or Credit Card Issuer

Branch

Account/Card No.

Checking:

Savings:

Credit Card:

Credit Card:

Credit references

Owed

Monthly payment

1.

2.

Have you ever filed for bankruptcy?            When and where?

Vehicle make & model:

Year:

License:

State:

Vehicle make & model:

Year:

License:

State:

Name

Address

Phone

Personal reference:

Personal reference:

Contact in emergency: