FUTURE RESIDENT APPLICATION

DATE:______________

OCCUPANT(S)

Name: ____________________________________________________________
(First) (Middle) (Last)
Current Address:____________________________________________________________
(City) ( State) (Zip)

Phone #:_______________________________

Work #:________________________________

Email Address:__________________________

ID/ DL #:________________________________________________________________

D.O.B:_______________________________

S.S. #:_______________________________

Co-Applicant:_________________________________________________________________

Phone #:_____________________________

Id/Dl #:______________________________

S.S#:________________________________

D.O.B#:______________________________

Email Address:__________________________________________

Any Other
Occupants:_______________________________________________________________

Best time to reach you?_______Morning Afternoon ____ Evening

Emergency Contact:_________________________ Relationship:_____________________

Emergency contact #:___________________________________________________________

EMPLOYMENT HISTORY

Your Status:_____Full Time_____Part Time_____Student_____Unemployed

Employer:___________________________________________________________________

Employer
Address:____________Indiana________________________________________________
(City) ( State) ( Zip)
Supervisor:_____________________________________________________________

Supervisor #:_________________________________________________________________

Salary:_________________________

Dates Employed:_______________________Employed As:_____________________

Co-Applicant Employer:_______________________________________________________

Employer Address:____________________________________________________________

Supervisor:______________________________

Supervisor #:_____________________________

Salary:____________________________

Dates Employed:_______________________Employed As:_______________________

What is your monthly budget?__________________________________________________

RENTAL HISTORY

Present
Address:___________________________________________________
(City) (State) (Zip)
Do you rent or own?___________________

Amount paid monthly:______________

Reason for leaving:_________________________________________________________

Landlord name:______________________________
Phone:________________________________

Previous Address:___________________________________________________________
(City) (State) (Zip)

Did you rent or own?_________________

Amount paid monthly?_______________________

Reason for leaving:__________________________

Landlord name:____________________________

Phone:_________812-886-4612_______________________

PERSONAL REFERENCES

1. Name:___________________

Address:_____________________________________________________
(City) (State) (Zip)

Relationship:________________

Phone:_____________________

2. Name:____________________

Address:______________________________________________________
(City) (State) (Zip)

Relationship:_____________

Phone:______________________

How did you hear about us? _____________________________________________________

OTHER INFORMATION

Pets:____________

Vehicles to be parked:_________________________________________________________
(make/model/year/ license #)
In the past, have you been delinquent in paying rent or other financial obligations?_________
If Yes, please
explain:_____________________________________________________________________

In the past, have you failed to perform any obligations of a rental agreement or have you been a
defendant in an eviction lawsuit?__________
If yes, please explain:___________________________________________________________

The information on this application is true and correct to the best of my knowledge. I hereby
authorize Rufus & Roxy, LLC or agents to verify the above information and obtain consumer
or investigative credit report, criminal background report, and/ or eviction records from Special
Services. I understand that the $50.00 fee for verifying this rental application is not a deposit,
will not be applied to any rent, or refunded even if the application to rent is declined. It is a
policy of Rufus & Roxy, LLC D.B.A Sunny Oaks Community that we do not accept
registered sex offenders.

ALL APPLICANTS MUST SIGN BELOW

SIGNATURE:_______________________________DATE:______________

SIGNATURE:______________________________ DATE:______________

FOR OFFICE USE ONLY:

APPROVED: ___________ DECLINED:____________