Credit Form Step 1 of 10 - Personal Information 0% Name of Applicant* First Last Telephone*Email* Enter Email Confirm Email Applicant's birthdateMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Today's Date MM slash DD slash YYYY Are you over 18? Yes No Social Security No. Driver's License No. Present Street Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Landlord and Phone No. Current Rent Amount Prior Street Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Prior Landlord and Phone No. How long have you lived at the present address? How long have you lived at the prior address? How many adults will be living in this unit?How many children will be living in this unit?How many pets will be living in this unit?What is the weight of pets in pounds?Employer Occupation Current SalaryHow long with employer (years & months)? Contact Person Telephone Is there a Co-Applicant?*NoYesName of Co-Applicant Co-Applicant Email Enter Email Confirm Email Co-Applicant's BirthdateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Co-Applicant TelephoneCo-Applicant Security No. Co-Applicant Driver's License No. Co-Applicant Employer Co-Applicant Occupation Co-Applicant Current Salary How long with employer (years & months)? Contact Person Contact Person Telephone Bank Name Bank TelephoneBank Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Checking Account No. Savings Account No. Number of vehicles (including company cars)Please list each vehicle below. Please include make, model, year, color, tag no. and state Have you ever filed for bankruptcy? No Yes If yes, when? Have you ever been served an eviction notice or asked to vacate a property you were renting? No Yes If yes, when and why?Have you ever willfully or intentionally refused to pay rent when due? No Yes If yes, why? How were you referred to us?NewspaperRealtorFriendSignOtherPlease provide a name of the referral source you listed above Rental Unit applied for Commencement Date MM slash DD slash YYYY Term Rent/Month Applicant hereby authorizes verification of any and all information set forth on this application, including release of information by any bank, savings and loan, employer (present and former), landlord, and/or other lender. All such information hereon, and released as authorized above, will be kept confidential. APPLICANT REPRESENTS THAT THE INFORMATION SET FORTH ON THIS APPLICATION IS TRUE AND COMPLETE. Material misrepresentation on this Application will constitute default under the lease or Rental Agreement between partiesSignature*Permission* I give permission to Plaza Realty to run my credit.