Mill City Properties - Rental Application (Long) | ph.978.937.2000

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Section 1 - About You:

Select the type of accomodations you are interested in:

Please select one or more of the following:

Furnished	Unfurnished
Short-term lease (< 12 mos)	2 months or longer
House	Apartment

When are you looking to move?

As soon as possible

Next month

Flexible (any time over the next few months)

Other (please specify):

Full Name (exactly as it appears on driver's license or gov't ID card:

First: Middle: Last:

Your E-mail address:

Former last names (maiden and married)

Home Phone #

Cell Phone #:

Work #

Your Social Security #:

Driver's license # and state:

Birth Date:
Sex:

Marital Status:	Single	Married	Divorced
	Widowed	Separated

Current address where you live:

Monthly rent: (specify utilities included)

Current owner or manager's name:

Their phone:

Date moved in:

Why are you leaving your present residence?

Your previous home address (street/city/state/zip):

Name of above owner or manager:

Their phone:

Previous monthly rent:

Date moved in:

Date you moved out:

Names and ages of children/occupants that will occupy apartment with you:

Section 2 - Your Work:

Present employer:

Employer address (street/city/state/zip):

Work phone:

Position:

Your gross monthly income is:

Date you began this job:

Supervisor's name and phone:

Previous employer:

Position:

Gross monthly income was:

Dates job began and ended:

List any other income:

List all regular monthly payments: (car payments, phone bills, credit cards, insurance, utilities, medical, etc)

Car Payment:		Credit Cards:
Child Support:		Alimony:
Car Insurance:		Other Insurance:
Mobile Phone:		Home Phone:
Other Payments:

Section 3 - Your Rental History:

Have you, your spouse, or any occupants listed above ever (check any that apply):

	Been evicted or asked to move out?
	Broken a rental agreement or lease contract?
	Declared bankruptcy?
	Been sued for nonpayment of rent?
	Been sued for damage to rental property?

If you checked any of the above items, please provide a brief explanation here:

Have you, your spouse, or any occupants listed above ever (check any that apply):

	Ever been convicted of a felony?
	Received deferred adjudication for a felony?

If you checked either of the above items, please provide a brief explanation here:

Your Vehicles (list all vehicles to be parked by you)
Make and color of vehicle:
Year:	License:	State:
Make and color of vehicle:
Year:	License:	State:

Emergency (Emergency contact person over 18, who will not be living with you)
Name:
Address (street/city/state/zip):
Work phone:
Home phone:
Relationship:

Authorization

Checking this box represents your legal signature of acceptance of the following statement:

I authorize Mill City Properties to verify the above information by all available means. Owner is not required to reverify or investigate preliminary findings.

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295 Dutton St., Suite 2, Lowell, MA. 01852 \| ph: (978) 937-2000 \| fx: (978) 455-3317 \| Copyright © 2024 Mill City Properties, Inc. All rights reserved.