ABCDEFGHIJKLMNOPQRSTUVWXYZ
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Citori II
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13229 Greensburg Pike
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Portage Ohio 43451
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419-308-2456
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Rental Information
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Credit check: __$0__Move in date:______________
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Applicant Information
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First Name: ____________________
Last Name: ________________
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Date of birth: ___________________
Social Security#: ________________________
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Phone: _______________________
Cell Phone: _______________
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License: ______________________
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Will any children under age 18 be living with you?
yes or no (circle one)
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How many: ____________________
Ages: ___________
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Current address
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Address: ______________________________________
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City: _________________________
State: ___________
ZIP Code: ____________
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Own or Rent (Please circle)
Monthly payment or rent: __$_______________
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Landlord: ______________________
Phone: ___________________
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Start date: ______________________
End Date: _________________
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Reason for leaving: ____________________________________________________
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Previous address
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Address: ______________________________________
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City: _________________________
State: ___________
ZIP Code: ____________
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Own or Rent (Please circle)
Monthly payment or rent: __$_______________
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Landlord: ______________________
Phone: ___________________
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Start date: ______________________
End Date: _________________
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Reason for leaving: ____________________________________________________
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Employment Information
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Current employer: ________________________________________
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Position: ______________________
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Manager: ______________________
Phone: ___________________
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Address: ______________________________________
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City: _________________________
State: ___________
ZIP Code: ____________
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Start date: ______________________
End date: _________________
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Monthly pay: __$________________
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Personal References
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Name: ________________________
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Relationship: ___________________
Phone: ___________________
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Name: ________________________
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Relationship: ___________________
Phone: ___________________
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Banking Information
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Bank: ________________________
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Acct #: _______________________
Amount: __$______
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Bank: ________________________
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Acct #: _______________________
Amount: __$______
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Automobile Information
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Make & Model: __________________
Plate #: _________________
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Make & Model: __________________
Plate #: _________________
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Additional Income
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Income Source: __________________
Amount: __$______
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Verify with: ____________________
Phone: ___________________
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Additional Information
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Have you ever been convicted of a crime?
yes or no (circle one)
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Describe and date each one: _________________________________________________
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____________________________________________________________________
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Have you ever been evicted, declared bankruptcy or had a judgement?
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yes or no (circle one)
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Describe and date each one: _________________________________________________
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____________________________________________________________________
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Co-Applicant/Spouse Information
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First Name: ____________________
Last Name: ________________
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Relationship to applicant: ___________________________
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Date of birth: ___________________
Social Security#: ________________________
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Phone: _______________________
Cell Phone: _______________
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License: ______________________
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Current address
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Address: ______________________________________
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City: _________________________
State: ___________
ZIP Code: ____________
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Own or Rent (Please circle)
Monthly payment or rent: __$_______________
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Landlord: ______________________
Phone: ___________________
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Start date: ______________________
End Date: _________________
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Reason for leaving: ____________________________________________________
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Previous address
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Address: ______________________________________
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City: _________________________
State: ___________
ZIP Code: ____________
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Own or Rent (Please circle)
Monthly payment or rent: __$_______________
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Landlord: ______________________
Phone: ___________________
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Start date: ______________________
End Date: _________________
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Reason for leaving: ____________________________________________________
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Employment Information
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Current employer: ________________________________________
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Position: ______________________
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Manager: ______________________
Phone: ___________________