The Village Quarter Apartments : Rental Application

The Village Quarter Apartments	FAX - (812) 877-2506
	Phone - (812) 877-1795
Date Printed:

Please print this page and fill in the form below, sign it and fax it to The Village Quarter: (812) 877-2506

If you can read this text on the printed version, do not FAX

Only the form will print on this page. If you see the title graphic above on the printed version, your browser does not support media dependent Cascading Style Sheets. You will need to print the PDF version instead. To test whether your browser is capable or not, you can print this page. If you can't see any text that says, "do not fax" on the printed version, and you can't see the site navigation graphics at the top, you're probably OK to print the application and FAX it.

If you know your browser does support media dependant Cascading Style Sheets can fill the application out online. NOTE: A signature is required, so you cannot submit the application online, but you can fill it all out and print it with your information neatly typed.

If you have any questions about what type of information to include on the application, please don't hesitate to call us: (812) 877-1795

Application to Rent

Date:

How did you hear about The Village Quarter?

Name:

Social Security Number:

Address:

Phone:

City:

State:

Zip:

Present Rent:

Landlord

Phone:

Spouse's Name:

Social Security Number:

Date Of Birth (Applicant)

(Spouse):

Employment Information

Employer:

Phone:

Address:

Position:

Income:

Spouse Employer:

Position:

Income:

How Long Employed?:

Spouse:

Previous Employer (if less than one year):

References

Name of Bank (City & State):

Personal 1.:

Phone:

Personal 2.:

Phone:

Emergency Contact:

Phone:

Nearest Relative:

Phone:

Other

Names of Residents to Occupy Apartment:

Renters Insurance Required:

Agent:

(Copy of Declaration Page Required)

Have you ever filed a petition for bankruptcy?:

If YES, What Year?:

Have you ever been evicted from any tenancy?:

The Applicant has submitted a $25.00 Application Fee for the expense of processing this application. If the application is approved, $15.00 of the fee will be applied to the first month's rent. Should the Applicant cancel after a 24 hour period, the Lessor/Owner shall be entitled to a cancellation fee of $100.00.

I/We have applied to lease the property known as _________________________, Terre Haute, IN 47803, for a term of ________________ beginning ________________ at a monthly rental rate of $_________________. I also hereby understand that all utilities including Electric, Water, Sewage, Phone, & Cable are the responsibility of the resident.

I/We the Applicant(s) hereby state that the information provided is true and correct and hereby authorize the Lessor to make any investigation of my personal history, employment, financial and credit records.

Signature:

Date:

Signature:

Date:

Authorized Agent:

Date:

Accepting on behalf of The Village Quarter

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