To apply for Aurora Pointe or Ridge Creek apartments, please e-mail paula@oroszproperties.com or call 608-242-8912. Address Applying For * - Select -The EmbassyBedford Crossing504 West Johnson St.520 West Johnson St.522 West Johnson St.505 Conklin Place308 North Bassett St.312 North Bassett St419 North Pinckney St Apt. # Rent Security Deposit Amount Special Terms or Conditions (Renovations required, pets, etc.) Applicant's Email Address * All information requested below must be provided in order to process this application. Applicant is entitled to review the lease, rules and regulations, previous tenant damages, and other forms as may be required by law for occupancy, and in signing this form attests that this information has been provided to their satisfaction. The Fair Credit Reporting Act, Public Law 91-508, requires that we notify you that as a part of our normal procedure, routine inquiries will be made to provide information concerning character, general reputation and style of living. Upon written request, the nature and scope of any report, if one is made, will be provided. Do you wish to receive a written explanation of a denial of tenancy? Yes No Name of Person(s) To Occupy Apartment (All occupants must be listed if more than one). 1. * Birth Date * Year Year1919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 SS# Phone # * 2. Birth Date Year Year1919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 SS# Phone # 3. Birth Date Year Year1919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 SS# Phone # 4. Birth Date Year Year1919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 SS# Phone # 5. Birth Date Year Year1919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 SS# Phone # Present Address How Long? Rent Paid Present Landlord How Long? Phone # Previous Address How Long? Rent Paid Previous Landlord How Long? Phone # Employed By How Long? Phone # Position Supervisors Name Applicant's Income/Monthly Credit References Name Address Telephone # Bank Name Car Make License Plate # Drivers License # Emergency Name Relationship Telephone # Street Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Receipt in the sum of $ is hereby acknowledged. This deposit will be returned to the undersigned if this application is not accepted. If accepted, this sum will then be applied to the security deposit required and/or the first month’s rent. All applications are subject to approval of owner or managing agent. Upon acceptance, applicant agrees to pay the balance of any amount due on the security deposit, plus the first full months rent. If the applicant refuses to sign the lease after this application has been approved, OR does not take occupancy, they forfeit the costs of application processing and advertising. In signing this form, they attest that they have never been evicted or declared bankruptcy. Applicant understands that this form is NOT a rental agreement or contract. Date Year Year20172018201920202021 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Applicant's Signature Rental Agent In case of emergency contact the following FAMILY MEMBERS: Leave this field blank
