1 Up Lead Services

Applicant
APPLICANT NAME
TELEPHONE NUMBER
DATE OF BIRTH
CURRENT STREET ADDRESS
CURRENT CITY, STATE, ZIP
HOW LONG AT CURRENT ADDRESS?
CURRENT LANDLORD NAME
CURRENT LANDLORD PHONE

PREVIOUS STREET ADDRESS
PREVIOUS CITY, STATE, ZIP
HOW LONG AT PREVIOUS ADDRESS?
PREVIOUS LANDLORD NAME
PREVIOUS LANDLORD PHONE

CO-APPLICANT
CO-APPLICANT NAME
TELEPHONE NUMBER
DATE OF BIRTH
CURRENT STREET ADDRESS
CURRENT CITY, STATE, ZIP
HOW LONG AT CURRENT ADDRESS?
CURRENT LANDLORD NAME
CURRENT LANDLORD PHONE

PREVIOUS STREET ADDRESS
PREVIOUS CITY, STATE, ZIP
HOW LONG AT PREVIOUS ADDRESS?
PREVIOUS LANDLORD NAME
PREVIOUS LANDLORD PHONE

ADDITIONAL APPLICANTS (CHILDREN)

LAST, FIRST NAME
LAST, FIRST NAME
LAST, FIRST NAME
LAST, FIRST NAME
LAST, FIRST NAME

SECTION 8 (IF APPLIES TO YOU)

CASE WORKERS NAME
CASE WORKERS PHONE
CASE NUMBER

DSS (IF APPLIES TO YOU)

CASE WORKERS NAME
CASE WORKERS PHONE
CASE NUMBER

AUTOMOBILE

MAKE
MODEL
COLOR
YEAR
PLATE NUMBER

ADDITIONAL QUESTIONS

HAVE YOU EVER BEEN EVICTED, IF SO WHY?

HAVE YOU EVER COMMITED A CRIME, IF SO WHAT?

BY CLICKING SUBMIT YOU ARE AGREEING TO THE FOLLOWING; A BACKGROUND CHECK, A CRIMINAL CHECK, AN EVICTION CHECK,VERIFICATION OF AN ACTIVE PUBLIC ASSISTANCE CASE (IF APPLICIBLE), AND ANY OTHER CHECK NEED TO CHECK YOU QULIFICATIONS FOR TENANCY. THIS APPLICATION IS NOT AN ACCEPTANCE OF TENANCY!