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Full Name of Landlord/Realtor/Company requesting screening:
I, , on the date of ,
hereby allow Apartments Aplenty, Inc., to inquire into my credit file, criminal, employment, and rental history to obtain information. I understand that on my credit file it will appear that LexisNexis and or Apartments Aplenty, Inc. have made an inquiry. I cannot claim any invasion of privacy against them now or in the future. I understand the application fee in the amount of $51.95 is a non-refundable charge in the event the application is approved or not approved.
Name:    First:     MI:     Last: 
SSN:     Date of Birth: 
Driver's License Number:     State: 



Current Address: 
City:     State:     Zip Code: 
Date moved in current address:
Current Landlord:     Phone#: 
Previous Address 
City      State      Zip Code 
Move In Date:     Move Out Date: 
Previous Landlord:      Phone: 



Employer:      Phone#: 
Employer Address: 
Start Date  Gross Monthly Income: 


Ever been arrested?  NO YES


Ever been evicted? NOYES
Ever filed bankruptcy? NOYES If yes, date filed: 
Late credit payments? NOYESCollections on credit? NOYES
Your phone number:
Enter your full name:      Date:
This is your digital signature.
By checking this box you agree that all information in this form is correct.