Old Town Realty


Address of House/Apartment:

Personal Information
Full Name:
Phone Number:
Email Address:
Social Security Number:
Date of Birth:
Permanent Address:
In Case of Emergency Call:	at:

Residence History
Present Address:	Since:
Landlord:	Phone:

Scholastic Information
Are You A Student?	Yes No
At What University?	Class Of:

Financial Information
Employer:	Since:
Full Part Time Summers Only Monthly Income:
Other:	$/Month: (ie. Student Loans, Parents, etc.)

Legal History
Have you ever been convicted of a felony?	Yes No
Are you a registered sex offender?	Yes No
Have you ever been evicted?	Yes No

Note: The house/apt. will NOT be reserved until we receive the initial deposit.

Old Town Realty agrees: I. That if the applicant(s) are not approved, any deposit will be refunded. The Applicant agrees: II. To execute the lease and pay the balance of the security deposit within one week. III. That if the lease is not executed within one week, or if the applications are withdrawn by the applicant, there will be a forfeiture of 50% of this deposit. IV. That the first month's rent has not been paid and is due in full when you pick up your keys at the beginning of the lease. V. To give Old Town Realty permission to obtain a credit report and authorize any current/previous landlord(s) to release information relating to payment/residence/personal history etc.