Apply

Co-applicant Information, If Married

Name

Date of Birth:

SSN:

Phone:

Co-App's current address:

City:

State:

Zip:

Own / Rent

Own
Rent

Monthly Payment

How Long

Previous Address:

City:

State:

Zip:

Own / Rent

Own
Rent

Monthly Payment

How Long

Co-applicant Employment Information

Current Employer:

Employer Address:

How Long?

Phone:

E-Mail:

Fax:

City:

State:

Zip:

Position:

Hourly/Salary:

Hourly
Salary

Annual Income:

References

Name:

Address:

Phone:

Address:

Name:

Phone:

Name:

Address:

Phone:

Residence History

Street, City, State, Zip

Owner Manager Number:

How Long?

Reason For Leaving:

Rent Paid in Full?

Yes
No

Did you give notice YES/NO

Yes
No

Were you asked to leave?

Yes
No

General Information

Have you ever been served a late rent notice?

Yes
No

Is anyone living with you a smoker?

Yes
No

When can you move in?

Apartment Size Preference

1BR
2BR

Referral Source:

Consent*

I authorize the verification of the information provided on this form as to my credit and employment. I have received a copy of this application.

Agreement & Authorization Signature
I believe that the statements I made are true and correct. I hereby authorize credit and/or criminal check to be made, verification of information I provided and communicate with any and all names listed on this application. I understand that any discrepancy or lack of information may result in rejection of this application. I understand that this is an application for an apartment and does not constitute a rental or lease in whole or part. I further understand that there is a non-refundable fee to cover the cost of the processing of my application and I am not entitled to a refund even if I do not get the apartment. Any questions on rejected applications must be submitted in writing and accompanied by a self-addressed stamped envelope by mailing to Copech Properties LLC 1800 Riverside Drive Monroe LA 71201.

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Application Fee*

Price:

Total

$0.00

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Comments

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Step 1 of 2 - Page 1

Application Information

Current Address

Previous Address

Employment Information

Emergency Contact

Co-applicant Information, If Married

Co-applicant Employment Information

References

Residence History

General Information

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