Centralia Stationery Apartment Rental Application

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Name (First Middle Last): *

Current Address:
*

Rented from (date) to (date) *

Phone *

Work Phone *

Marital Status *

Married

Single

Required

Date of Birth *

Driver's License Number/State *

Current Employer/Supervisor/How Long Employed *

Monthly Salary *

Have you ever been evicted *

Yes

Required

Landlord/Manager Name & Phone *

Why are you leaving your current address? *

All occupants over 18 years of age must complete a separate application.

Additional Occupant (Minor) Proposed to live with you. Name/Relationship/Date of Birth

Past Landlords, Current and/or Previous Employers and other References may be contacted. Upon completion of this pre-screening application, a signed application will be required.

No Smoking - No Pets

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