Your Name:
Your Contact info:
Is there anyone else who will be living with you? (If yes, list name and relationship to you.)____________________________
Are there pets that will be living with you? (If yes, describe pet.)___________________
Date that you would like to move in._______________________
Length of time that you would like to live here._________________


Will you be able to do the following;
Pay the rent plus 1/2 of the utilities on time?_______
Keep noise levels low?______
Clean after yourself in a timely manner?______
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Are you an early riser, or a night owl?_______________
How often do you wash your dishes?_____________________
When do you sweep the floor?___________________
What are you looking for in a place to live?


REFERENCES.
Your last fixed residence: _______________________
Dates that you lived there: _______________________
Landlord's name and phone number: ______________________________

Employment reference:
Your place of employment: _________________________
Dates employed there._____________________
Contact person (Name, position, phone #)__________________________
If not currently employed, how will you pay the rent, bills?_________________________________________

Add other appropriate references if you wish (Name, relationship to you, contact info.) Hint: I do not have free long distance; each long distance call costs me about $2, so local references are appreciated if you have them.

Thank you!