Today's Date:

Address of Property:

Time period to be Occupied:

Your Name:
(Please Print)

Your Soc. Sec.#:

Present Address:

Telephone #:

Current Employer:

Address:

Supervisor:

Salary $: 

Telephone #: 

Parent's Name:
(Please Print)

Parent's Soc. Sec.#:

Spouse's Name:
(Please Print)

Spouse's Soc. Sec.#:

Parents Present Address:

Telephone #:

Parent/Spouse's
Employer:

Address:

Title:

Supervisor:

Salary $: 

Telephone #: 

Name: 

Address:

Home Phone #:

Work Phone #:

Relationship:

Number of occupants:

APPLICANT agrees that he/she is renting the premises in an "as is" condition and that he/she will comply with all State, Federal and local ordinances applicable to the demised premises and will save lesser harmless from penalties, fines, costs or damages resulting from failure to do so. Possession will be given only after execution of lease in form generally used and payment of deposit and first month's rent. It is hereby understood that the owner has the right to reject this application.

Applicant understands that monies received by owner for security deposit will be used as an application fee until the lease is signed by all signatories. At that time monies will ripen into a security deposit. Applicant understands that in the event applications and lease are not returned within 5 BUSINESS DAYS, Lloyd Hudson Rentals will deduct the cost of Federal Expressing said application and lease to each parent. At that time applicant will call and make arrangements to pick up the remainder of application fee. If the monies are received other than cash and the lease is not completed for any reason, the money will be returned only after a waiting period of 10 business days.

Occupant's Signature:

Parent's Signature: