* Apartment Desired:              Please Select One 24 Mellen Unit 1 24 Mellen Unit 3 24 Mellen Unit 4 24 Mellen Unit 5 24 Mellen Unit 6 24 Mellen Unit 7 24 Mellen Unit 8 44 Spruce Unit 1 44 Spruce Unit 2 44 Spruce Unit 3 46 Spruce Unit 1 46 Spruce Unit 2 46 Spruce Unit 3 30 State Unit 2 30 State Unit 4 30 State Unit 6 30 State Unit 8 32 State Unit 1 32 State Unit 3 32 State Unit 5 32 State Unit 7    *Number of Occupants:           1 2 3      *Pets:           Choose None 1 Cat 2 Cats Dog

ABOUT YOU

* Applicant's Name:                    * Social Security Number:             

* Current Address:                    

* Telephone Number             

* Email Address:                 

* Current Landlord:                   * Landlord's Phone:             

* Previous Address: 

   Previous Landlord:      Telephone:

* Employer or Source of Income:          

* Contact Person:                * Telephone:          

* Personal Reference:                * Telephone:          

   Year and Make of Auto:      Plate Number:

ABOUT THE CO-APPLICANT

Co-Applicant Name:      Social Security Number:

Current Address:     

Telephone:

Current Landlord:      Landlord Phone:

Previous Address:

Previous Landlord:      Telephone:

Employer or Source of Income:

Contact Person:      Telephone:

Personal Reference:      Telephone:

Year and Make of Auto:      Plate Number:

   By Checking this box, I hereby authorize priceapartments.com or any agent of priceapartments.com to contact my landlord, previous landlord, employer and personal reference as listed above for the purpose of obtaining a housing reference.

   By checking this box, I hereby authorize priceapartments.com or any agent/servant/employee of priceapartments.com to contact any prior employers, companies, credit bureaus, law enforcement agencies and/or consumer reporting bureaus, including but not limited to Tenant-Net, Inc., for the purposes of verifying, confirming and recording the above information which I herein state is true to the best of my knowledge and belief.  I authorize and consent to the recording, release and re-publication of this information by Tenant-Net, Inc., without further permission, fee or compensation; and hereby release the above and their agents/servants and employees, including Tenant-Net, from any and all liability and responsibility for said re-use.

Additional Information/Comments: