Your Name: Today's Date
Your Current Address: (Address, City, State, Zipcode)
Your Home/Cell Phone# : Your Work Phone# :
E-mail Address: Date of Birth:
Your Driver's License # : State Driver's License Issued:

How many total people will live in the dwelling:
Who else other than yourself will live in the dwelling and what is their relationship to you?

Do you own any pets? Yes No if yes, what type and how many?

Who is your present landlord and address?
(Name of Company, Street Address, City, State, Zip, Phone Number)
When did you move in?
When does your lease end?
How much is your present rent? Why do you want to move?
Have you notified your landlord of your desire to move? Yes No Is your landlord asking you to move? Yes No
Have you ever been evicted? Yes No If yes, why?
Who did you rent from before your current Landlord? (Name or company)
and the Street Address: City: State: Zip code:

What is your main source of income? What is your monthly gross income?
Describe any other income:
If employed, whom do you work for and what do you do? (Company Name, Position)
How long have you been employed with this particular company?
What is your supervisor's name and phone number? (Name, Phone number)

Who do you bank with? Account #
Have you ever declared bankruptcy? Yes No If yes, when?
Describe the vehicles you plan to keep at the dwelling:

Have you ever been convicted of, or pled guilty or plead no contest to a felony whether or not resulting in a conversion?
Yes No If yes, explain:
Have you ever been convicted of, or plead guilty or plead no contest to a misdemeanor involving sexual misconduct whether
or not resulting in a conviction? Yes No If yes, explain:
Are you or any member or this household considered a sex offender by any legal jurisdiction in the United States?
Yes No If yes, explain:

Please give us the names of 2 unrelated persons who have known you for at least 2 years.
(Name, Relationship, Full Address, Phone #)
(Name, Relationship, Full Address, Phone #)

In case of an emergency, whom should we contact?



The undersigned does hereby state and swear that all information contained in this rental application is true and accurate. Providing false, incomplete or misleading information in this application shall be cause for immediate termination or any subsequent lease agreement and/or occupancy at the option of the lessor. Lessor is granted permission to gather information regarding applicant, and to verify the validity of all information contained in this application, including the conduction of credit reports, before, during and after occupancy. Employers, landlords, references and others are hereby granted full permission to release any information requested by the lessor. The applicant hereby waives any claim for damages by reason of non-acceptance of this application which the Landlord or his agent may reject without stating reasons for doing so, and applicant agrees to release Lessor, its employees and agents from all liability for any damage whatsoever incurred in furnishings or obtaining the information necessary to process this application. Applicant's withdrawal of this application after submission may result in the retention of all or part of the posted security deposits as liquidated damages. Submit rental applications to The Courtyards of Miami, 5 East Central Avenue #5, Oxford, OH 45056.

TO AGREE TO THIS APPLICATION AND THAT ALL INFORMATION IS TRUE AND ACCURATE PLEASE PRINT AND SIGN YOUR FULL NAME AND DATE IT BELOW. THEN SEND THIS APPLICATION TO THE OFFICE AT:

The Courtyards of Miami
5 East Central Avenue #5
Oxford, OH 45056


Your Full Name: Date: