Contact Connecticut Cottages

APPLICATION FOR RESIDENCY FORM
( Must be Completed in Full)

Applicant

First Name, Middle Initial
Last Name
Social Security #	- -
Driver's License # & State
Date of Birth (MM/DD/YY)	/ /

Others Who will Reside in Apartment	(All applicants over the age of 18 who will be residing on the premises must fill out a separate application)

First Name, Middle Initial
Last Name
Social Security #	- -
Relationship
Date of Birth (MM/DD/YY)	/ /

First Name, Middle Initial
Last Name
Social Security #	- -
Relationship
Date of Birth (MM/DD/YY)	/ /

First Name, Middle Initial
Last Name
Social Security #	- -
Relationship
Date of Birth (MM/DD/YY)	/ /

Present Address

Street Address, Apt.#
City, State, Zip Code
Area Code and Telephone
Rent Own	Monthly Payment $ Years There
Landlord or Lender
Area Code and Telephone
Full Address

Previous Address

Street Address, Apt.#
City, State, Zip Code
Area Code and Telephone
Rent Own	Monthly Payment $ Years There
Landlord or Lender
Area Code and Telephone
Full Address

Current Employer

Name
Full Address
Supervisor
Supervisor Area Code and Telephone
Employment Date (MM/DD/YY)	/ /
Position
Salary	$

Previous Employer

Name
Full Address
Supervisor
Supervisor Area Code and Telephone
Employment Date (MM/DD/YY)	/ /
Position
Salary	$

Bank References

Name of Bank
Location
Bank Area Code and Telephone

Credit References

Account Type
Name of Bank
Balance Owed & Monthly Payment	$ $

Other Sources of Income

Type of Income
Source/Bank

Type of Income
Source/Bank

Explain any "YES" answers below:

Have you ever been sued for bills?	Yes No
Have you ever broken a lease?	Yes No
Have you ever been sued for eviction?	Yes No
Convicted of a drug related offense?	Yes No
Convicted of a felony?	Yes No
Are you listed as a sexual predator or are you under consideration for such a listing?	Yes No

Please explain any "YES" answers: (Use as much space as you need)

Relative/Emergency Contact	(Not Residing With You)

Name
Full Address
Relationship
Area Code and Telephone

ABSOLUTELY NO DOGS, CATS OR OTHER PETS PERMITTED AS PER LEASE. INITIAL HERE ACKNOWLEDGING THAT YOU HAVE READ THIS:

I hereby agree that all the information provided in this application is true and correct and has not been misrepresented in any way. If I have provided false information or have misrepresented any of the information in this application, I understand that my application will be denied residency. If the misrepresentation or false information is discovered after a rental agreement has been signed, I understand that my tenancy will be terminated. All persons named in this application may freely give any requested information concerning me and I hereby waive all rights of action for any consequence resulting form such information. I understand that I may be asked to make a good faith deposit which is conditionally refundable. If I am accepted for residency, this deposit shall be applied to the total security deposit under the lease agreement. I further understand that if I withdraw my application after screening expenses have been incurred, this good faith deposit will not be refunded. In all other cases, the deposit will be refunded.

By clicking the submit button below, I attest to the truthfulness and accuracy of the information submitted herein.

Website Design & Hosting by Computer Medic