P.O. Box 4331 Olathe, KS  66063 913-706-4400
RENTAL APPLICATION
Desired Date of Occupancy		Date of Application
Intended Use		Unit Applied For
Name	Last Name	First Name	Middle Initial
Check One:	Male Female
Date of Birth		SSN
Check One:	Married Divorced	Separated Single
Have you ever been:Convicted of a crime? Yes No		Involved in a legal dispute with a landlord?   No Yes
In case of emergency,notify:	Emergency Name	Emergency Address	Emergency Phone
RESIDENCE HISTORY
Present Address		Phone	How Long?
Landlord		Phone	Rent Amount
Previous Address		How Long?
Landlord		Phone	Rent Amount
Previous Address		How Long?
Landlord		Phone	Rent Amount
EMPLOYMENT REFERENCES
A.	From: To:	Employer	Phone
	Address	Position	Income
B.	From: To:	Employer	Phone
	Address	Position	Income
CREDIT REFERENCES
C.	Bank Reference	Contact	Phone
	Address	Acct. #	Acct. #
D.	Credit Reference	Contact	Phone
	Address	Acct. #
E.	Credit Reference	Contact	Phone
	Address	Acct. #
F.	Other Income (amount and source)
CHARACTER REFERENCES
1.	Name	Address	Phone
2.	Name	Address	Phone
	NUMBER OF VEHICLES	Drivers License #	State
	Year	Make/Model	License # Financed by
	Year	Make/Model	License # Financed by

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I understand that a full disclosure of pertinent facts including credit reports and police and public records may be made to the landlord or his agent.

I certify that the information supplied is true and correct to the best of my knowledge.