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Is there a particular community in which you are interested?:

Huntington Gardens
Covenanter Hill Neighborhood District
In Which Floorplan are you Interested:  
Desired Move-in Date: 

First Name:   Last Name:
Current address:
City: State: Zipcode:
E-mail address: Phone (home): Phone (work):
Minority:   
White:    Black:    Amer Indian:   
Alaskan native:    Asian:    Pacific Islander:
Ethnicity:
Non-Hispanic:
Hispanic:
Do you currently receive Section 8 assistance?:    No:    Yes:
If yes, enter:
Voucher:    Certificate:
Is the head of household or spouse Disabled or Handicapped?:  
 No:    Yes:
Household Composition:
Please list information on all persons who will be living in the home, including self:

Name:		 Relationship: M/F Birthdate: Soc. Sec. Number:
Income Information:
(Please show gross amount of annual income household currently receives)
Salaries or wages: $ Pension: $
SSI: $ AFDC: $ Child Support: $
Other: $ Source:
Employment Information:
(Please include yourself, spouse and/or other family members)
Family Member: Employer: How long? Hourly wage: Hours/week:
Assets:
(Please list the value of any assets you own)
Checking account balance: $    House: $    Mobile Home: $
Savings account balance: $ Other: $
Did you or any member of the household
        file a federal income tax return last year?    No:    Yes:
Have you disposed of any asset in the last 24 months
        for less than fair market value?    No:    Yes:
        If "Yes", explain:
Credit Information:
(List all open and closed accounts within the past 12 months)
Name of Creditor: Monthly Payment:
Rental History:
Most Recent Address:
 How long?
Landlord's Name:
Previous Address:
 How long?
Landlord's Name:
Are you, or is any member of the household, age 18 or older, a full-time student?
         No:    Yes:

Do you, or does any other member of the household, anticipate being a full-time student
         for at least 5 months of the next year?   No:    Yes:

How did you hear about us?
Please be very specific. We will be unable to process your application without this information.
Please read this section carefully, you must "sign" it before your application can be accepted. All household members older than 18 years of age must "sign" below. If home is for more than 2 adults, please fill out separate applications for each person.



Head of Household: By typing your name and clicking this checkbox , you acknowledge that you have read and accepted the above terms of this application. I accept the above terms (please type your full name, or sign it if you are sending in this form by fax or mail):

Name:  

 Date:

Other Adult: By typing your name and clicking this checkbox , you acknowledge that you have read and accepted the above terms of this application. I accept the above terms (please type your full name, or sign it if you are sending in this form by fax or mail):
Name:   

Date:
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