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Springfield Loft Apartments - Springfield Apartments Application

Lease Application
Please read the following before completing this form: Applicant represents that the informatio given in this application is complete and accurate and authorizes us to check with credit reporting agencies, credit references and other sources disclosed herin while investigating the information given.
  Firstname:   Email:
  Middle Initial.:      
  Last Name:      
  Current address:   Previous address:
  City:   City:
  State   State:
  Zip:   Zip:
  Years at address:   Years at address:
  Birthdate: DD MM YYYY   Emergency Contact Number:
  Home phone:   Emergency Contact Name
  Work phone:   Relationship:
           
  Place of employment:   Anual income from all sources
Former landlords: (if any)
  Name Name
  Phone:   Phone:
  Rental Property:   Rental Property:
  Have you ever been evicted from an apartment or house for any reason?   
  If yes, please explain:  

I hereby certify that all the information above is correct and truthful to the best of my knowledge:

In connection with this application, I authorize Palacio Properties LLC, and their respective agents to solicit information about my background, including but not limited to, information at to my employment, consumer credit history, criminal and/or public records history. I authorize all persons who may have information relevant to this investigation to disclose said information. I release from liability all persons, companies, governmental or other agencies and corporations disclosing such information. I hereby further authorize that a photocopy of this authorization may be considered as an original.