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Building Information Address applying for: or -------------Select------------- 614 S. Baldwin #3 614 S. Baldwin #4 8 N. Third St. 614 S. Baldwin #2 22 Sherman Terrace #3 22 Sherman Terrace #4 1145 Petra Place #3 1407 Williamson St. 610 S. Baldwin #2 with den (or 3 bedroom) 610 S. Baldwin #1 2033 Carey Court 614 S. Baldwin #1 610 S. Baldwin #2 1235 E. Johnson St 1409 Williamson St. 1231 E. Dayton
Personal Information
First Name: Last Name:
MI:
SS #
Email Address:
Date of Birth: 01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Home Phone:
Work Phone:
Cell Phone: Current Address:
City:
State:
Zip:
Country:
Date Moved In: 01 02 03 04 05 06 07 08 09 10 11 12
Date Moved Out: 01 02 03 04 05 06 07 08 09 10 11 12
Present Landlord:
Landlord Phone:
Landlord Full Address:
Reason for Moving: Previous Address:
From When to When: 01 02 03 04 05 06 07 08 09 10 11 12 to 01 02 03 04 05 06 07 08 09 10 11 12
Reason for moving:
Landlord Name:
Phone:
Additional Occupant Information List names, relationship, and birth date of all occupants, other than yourself who will live in the apartment:
Name:
Birth date: 01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Relationship:
Income Information During the term of your lease for this apartment, please list below your income source and amount.
Income Source: Phone Number to verify: Monthly amount: $
List below any Credit References such as loans, credit cards, etc.:
Name of creditor: Name of creditor: Name of creditor:
Have you or your spouse ever been evicted? Yes No Have you or your spouse ever been convicted of a felony? Yes No Have you or your spouse ever filed for bankruptcy? Yes No
Certification and Release: I hereby certify that, to the best of my knowledge, all of the information contained in this application is true and complete. I understand that if the management selects me (us) as residents, they may terminate the lease immediately if it learned that any of the information contained herein is false.
I authorize the management and its agents to thoroughly investigate and verify all of the statements contained herein. I understand the management may investigate my background as it pertains to housing and herby authorize the management to contact my references, landlords, and verify other statements on this rental application with respect to me or my spouse.
I hereby release and hold harmless the management and its agents from and against all actions, claims, costs, damages, expenses, liabilities, losses, and suits arising out of, or resulting from, the investigation pertaining to the information described above.
MSB Holdings 409 Ozark Trail Madison, WI 53705 Office: 608-213-6625 Email: msbholdings@yahoo.com www.msbholdings.com
