Application Form Please fill out the following form to apply for an apartment. PLEASE NOTE: A $40 application fee is required for each applicant. Property*Select a propertyCuster HouseElkhorn Lewis ApartmentsGreenfield ApartmentsLloyd DuplexRoosevelt ApartmentsApplicantApplicant Name* First Middle Last Suffix Email* Phone*Work PhoneSocial Security Number*Birth Date* MM slash DD slash YYYY DocumentsPhoto ID or Driver License*Max. file size: 50 MB.Social Security Card*Max. file size: 50 MB.Pay Stubs (1 Month)* Drop files here or Select files Max. file size: 50 MB. ResidenceCurrent Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long at current address?*Reason for moving?*Prior Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long at prior address?*EmploymentApplicant Occupation*Company*How long?*Total Monthly Income*Supervisor*Co-Applicant / SpouseDo you have a co-applicant or spouse (anyone over 18)* Yes No Co-Applicant Name* First Middle Last Suffix Social Security Number*Co-Applicant Occupation*Company*How long?*Total Monthly Income*Supervisor*Financial AccountsChecking Account Bank Name*Checking Account Balance*Savings Account Bank NameSavings Account BalanceCredit Card AccountsCard 1 NameMonthly PaymentBalanceCard 2 NameMonthly PaymentBalanceCard 3 NameMonthly PaymentBalanceReferencesName 1*Phone*Name 2*Phone*Current Landlord*Phone*Previous Landlord*Phone*VehiclesAutomobile 1 MakeAutomobile 1 ModelAutomobile 1 YearAutomobile 1 ColorAutomobile 2 MakeAutomobile 2 ModelAutomobile 2 YearAutomobile 2 ColorOther InfoChildren AgesClick plus sign to add more Do you have pets?* Yes No Describe your petsDo you own a vacuum?* Yes No Do you smoke?* Yes No Have you ever been evicted?* Yes No If yes, please explain*Have you ever failed to timely pay rent?* Yes No If yes, please explain*Have you ever filed for bankruptcy?* Yes No If yes, please explain*Sign-offDisclosure/Agreement Consent*I/We understand that CHRISTIAN BUETTNER is an agent of PRESCIENT PROPERTY GROUP I/We hereby give permission and authorize CHRISTIAN BUETTNER to conduct an employment/credit check concerning my/our application and to verify all references. I/We declare that all information listed on this application is true and accurate. I/We agree to the above statementApplicant Signature*By entering your name in the field below, you are signing this application.Co-Applicant Signature*By entering your name in the field below, you are signing this application.CommentsThis field is for validation purposes and should be left unchanged.