The management of this community offers Equal Housing Opportunities. We do business in accordance with the Federal Fair Housing Law and do not discriminate against any person because of race, color, religion, sex, handicap, familial status, or national origin.

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Applicant Information
* Email Address:
Requested Address:				Date:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Zip:
Applicant Name:				DOB:
Social Security #:
Driver's License #: Photo ID:	State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
Co-Applicant Name:				DOB:
Social Security #:
Driver's License #: Photo ID:	State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
Full Names of All Other Residents Relationship to You Date of Birth
Do you have any pets? Yes No If yes, indicate all of the following:
Kind: Weight: Breed: Age:
How did you hear about our property?
Present Address:				Years:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Zip:
Owner/Landlord Name:				Phone:
Previous Address:				Years:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Zip:
Phone:
MFG of Home:	Serial #: Year:
Size:	Selling Dealer/Owner: Phone:
Price of Home:	Salesperson's Name:
Finance Company:	Gross Annual Income:
Monthly Home Payment:	Down Payment Amount:
References
Bank Name: Type... Savings Checking Account #: Credit Card #: Type... Visa Mastercard Discover Expires: 01 02 03 04 05 06 07 08 09 10 11 12 / 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Amount Owed: Monthly Payment: Credit Card #: Type... Visa Mastercard Discover Expires: 01 02 03 04 05 06 07 08 09 10 11 12 / 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Amount Owed: Monthly Payment: Open Account: Phone: Amount Owed: Monthly Payment:
Personal Reference 1:
Address:				Phone:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Zip:
Personal Reference 2:
Address:				Phone:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Zip:
Emergency Information
In case of emergency notify:
Emergency Name:	Relationship:
Emergency Address:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Zip:
Phone:
Employer Information (Letter of Employment Required)
Current Employer:	Years:
Address:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Zip:
Phone:
Position:	Salary:
Supervisor:	Phone:
Co-Applicants Current Employer:	Years:
Address:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Zip:
Phone:
Position:	Salary:
Supervisor:	Phone:
Previous Employer:	Years:
Address:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Zip:
Phone:
Position:	Salary:
Supervisor:	Phone:
Co-Applicants Previous Employer:	Years:
Address:
City:		State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	Zip:
Phone:
Position:	Salary:
Supervisor:	Phone:
How many vehicles (including company cars) would you keep at this address?
Make Color Year Lic. Tag No. State
Have you or your co-applicant ever:
Been sued for non payment of rent? If yes, please explain: Yes No
Declared bankrucptcy? If yes, please explain: Yes No
Broken a lease or Rental agreement? If yes, please explain: Yes No
Been evicted from any type of housing? If yes, please explain: Yes No
Have you or any resident in your proposed home ever been convicted of a felony? If yes, please explain: Yes No
This form creates no obligation to you. By submitting this application, you agree to allow Rolling Acres Estates to review your credit history with the local credit bureau.