Victory Place Lease Application

Lease Application

Name:							Current Address:
S.S.#							City:
Home Phone:							State:
Home Phone:							State:
Cell Phone:							Zip:
Email:* Required							Rental Amount:
Date of Birth:							Lease Expires:
Drivers License Number:							How long have you lived there:
Auto Make and Model:							Landlord Name:
Are vehicled insured:							Landlord Phone Number:
							Reason for leaving:


Gross Monthly Income:( Before Taxes)
Current employer:							Work Phone:
Supervisor:							Years employed:
Other Income per month: (Please specify amount of Alimony, Child Support, or other income you receive per month.)
Ever filed bankruptcy?							Explain:

Discharge Date:
Ever been evicted or foreclosed?							Explain:
Ever been convicted of a felony?							Explain:
Are you required to register as a Sexual Offender?							Explain:
Pet Information: Pet Name: Age: Weight ibs.: Spayed/Neutered: Pet Name: Age: Weight ibs.: Spayed/Neutered:
Applicant represents that all the above statements are true and correct and hereby authorizes verification of the above statements and Information, including but not limited to the obtaining of a credit report and tenant history report and agrees to furnish additional information on request. I agree that Victory Place, Ltd. may terminate any agreement entered into on reliance of any misstatement made above. Name: Date:
Comments: