Contact Information

First Name *

Last Name *

Social Security # *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Birthdate *

Previous address if your current is less than 2 years

Street Address

Address Line 2

City

State

Zip Code

Have you ever been convicted of a crime? *

No

Yes

If "yes" what was the nature of the crime?

Have you ever filed for bankruptcy? *

No

Yes

Date of bankruptcy

Employment Information

Current Employer *

Annual salary *

Supervisors First Name *

Last Name *

Employer Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Property resident information (names of the individuals living in the apartment)

#1 First Name

Last Name

Birthdate

#2 First Name

Last Name

Birthdate

#3 First Name

Last Name

Birthdate

#4 First Name

Last Name

Birthdate

#5 First Name

Last Name

Birthdate

Renters Insurance

Would you like information on personal renters insurance? Renters insurance provide insurance coverage on your personal belongings. *

Yes

No, I have my own coverage

Decline, I am not interested

Authorization and Payment

I hereby authorize, without reservation, any and all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state and county courts, military services and persons, to release information they may have about me to Contemporary Short Term Housing. This releases the aforesaid parties, from any liability and responsibility, for collecting the above information. I further acknowledge that a telephonic facsimile shall be as valid as the original

Yes

No

Name on Card

How would you like to pay the application processing fee?

Credit Card Type

Credit Card Number

CVV

Expiration Date (mm/yy)