Application For Housing Lease

Madison Heights

1300 Osage Drive

Madison, IN 47250

(812) 273-5057

twaltz@roadrunner.com

 

The following information will be submitted to prior landlords and employers for references. A copy of a recent credit report from www.annualcreditreport.com is required as an attachment to this application. Please send a copy of this report to twaltz@roadrunner.com or mail/hand deliver to the rental office.

Date of Application:

Names of All Occupants

1)

2)

3)

4)

Social Security #:

Relationship:

Relationship:

Relationship:

SS#:

List Last Two Addresses & Landlord/Mortgagor Information

Current or Most Recent Address:

Phone Number:

How Long at This Address:

Landlord/Mortgagor:

Landlord’s Phone #:

Reason for Changing Residence:

Previous Address:

Phone Number:

Arrival & Departure Dates:

Landlord/Mortgagor:

Landlord’s Phone #:

Employment Information

Employer:

Occupation:

Phone #:

Employer:

Occupation:

Phone #:

Approximate Household Monthly Income:

Type of Apartment Preferred

Miscellaneous Information

Date When Needed:

Number of Parking Spaces Needed:

Pets:

How Many:

What Type:

Best Time to be Reached and at What Number:

To submit this application, please do one of the following:

· Print, Scan, then Email to twaltz@roadrunner.com

· Print then Fax to (812) 265-3614

· Print then Mail/Hand Deliver to 1300 Osage Drive, Madison, IN 47250

Thank you for your interest. Tony will contact you after your application is processed.