RENTAL APPLICATION
MISSOURI BREAKS APARTMENTS RENTAL APPLICATION
602-279-6067 Fax 888-461-8724
The undersigned hereby makes an application to rent unit #_____________ located at:
1637 E. Missouri, Phoenix, AZ 85016.
Anticipated move date of ___________________at a monthly rent of $_______________ and
security deposit of $_______________.
PLEASE TELL US ABOUT YOURSELF
Full Name__________________________________________________
Home Phone ( ) ________________________
Date of Birth_________________________________
Social Security #__________________________________________
Email Address:__________________________________________(optional)
Other Phone ( ) ___________________
Co-Applicant Name_________________________________________ Names of
Dependents_________________________
Co-Applicant Date of Birth______________________
Social Security #__________________________________________
Dependents Date of
Birth_________________________________________________________________________
List All
Pets__________________________________________________________________________
PLEASE GIVE RESIDENTIAL HISTORY (LAST 3 YEARS)
Current Address_______________________________Apt#________ City__________________
State______ Zip________
Month/Year Moved In______________________
Reasons for Leaving____________________________Rent $__________
Owner/Agent__________________________________________________
Phone ( ) ____________________________
Previous Address (last 3
years)_________________________________________________________
Rent $____________
Owner/Agent__________________________________________________
Phone ( ) ____________________________
PLEASE DESCRIBE YOUR CREDIT HISTORY
Have you declared bankruptcy in the past seven (7)
years?
Yes___________ No____________
Have you ever been evicted from a rental residence?
Yes___________ No____________
Have you had two or more late rental payments in the
past year?
Yes___________ No____________
Have you ever willfully or intentionally refused to pay
rent when due?
Yes___________ No____________
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