Assured Property Management, L.L.C.

:: Rental Application

There is a $40 non-refundable processing fee for all applications. Upon submitting this application you will be prompted to pay the processing fee online.

If you prefer you may complete the application by downloading a pdf application and Missouri Broker Disclosure Form and delivering the application with the $40 fee to the APM office.

Please tell us about yourself

Full Name

Date of Birth

Social Security #

Drivers Liscense #

Present Phone

Cell Phone

Are you a student?

Yes No

List all people who will reside in the unity in addtion to the applicant:

Name

Gender

Date of Birth

Relationship to Applicant

	Male
	Female

	Male
	Female

	Male
	Female

Do you have pets?

Yes No

How Many?

What kind, breed and age?

Pet policies, fees and deposits differ by property. Please ask leasing agent.

Rental/Residence history for the last 3 years
(beginning with the most current)

Applicant Current Address
Month & Year Moved In		Reason for Leaving
Owner or Agent		Phone
Monthly Rent
Applicant Previous Address
Month & Year Moved In		Reason for Leaving
Owner or Agent		Phone
Monthly Rent

Applicant Employment History

Your Current Status:	Employed Part Time Employed Full Time Retired Not Employed
Applicant current/most recent employer
Address		Phone
Dates Employed	From To
Position		Supervisor
Gross Monthly Salary		Length of Employment
If there are any other sources of income you would like us to consider, please list. You do NOT have to reveal alimony, child support or spouse's annual income unless you want us to consider it in this application.
Amount		Source

Applicant Banking Information

Bank		City/State
Bank		City/State

Applicant Vehicle Information

Have you ever:

Been sued for non payment of rent?	Yes	No
Been evicted or asked to move out?	Yes	No
Broken a Rental Agreement or Lease?	Yes	No
Been sued for damage to rental property?	Yes	No
Declared Bankruptsy?	Yes	No
Been arrested/charged/convicted/pled guilty or placed on probation for any crimes?	Yes	No
If yes, details:

I declare the foregoing to be true under penalty of perjury. I certify that I have read a copy of the "Missouri Broker Disclosure Form".

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