CO-APPLICANT INFORMATION. RELATIONSHIP TO PATIENT 🞎 Self 🞎 Spouse / Domestic Partner 🞎 Parent 🞎 Other Name (Last, First, MI) Last 4 Digits of SSN U.S. CITIZEN 🞎 Yes 🞎 No Date of Birth Number of Dependents (other than self & co-applicant) Ages of Dependents Primary Contact - Phone ( ) Street Address (Do Not Provide PO Box) City State County ZIP Code 🞎 Permanent Address 🞎 Temporary Address Current Employer Street Address, City, State Position If you are not working, how long have you been unemployed?
CO-APPLICANT INFORMATION. (COMPLETE ONLY IF CO-APPLICANT REQUESTING A “GE MONEY CREDIT CARD”) Date of Birth / / Home Phone Number ( ) Cell/Other Phone Number ( ) *If the above address is a P.O. Box, you must provide a street address for yourself or a contact person. ❑ Your Address? Contact Person Name Street Address (Street Name and Number) ❑ Contact Person? City State Zip Alimony, child support or separate maintenance income need not be disclosed unless relied upon for credit. Monthly Net Income From All Sources $ Employer’s Phone Number ( ) Housing Information ❑ PARENTS/RELATIVE ❑ RENT ❑ OWN ❑ OTHER Time at Address Years Months Mailing Address Apt.# City State Zip Social Security Number - - Name (First-Middle-Last) Please Print E-Mail Address (optional)
CO-APPLICANT INFORMATION. Your spouse is NOT presumed to be a Co-Applicant. They MUST be added and present an I.D. at application time. No information will be shared unless they are on this application! -Co-Applicant Name: First: Last: DOB: / / SSN: / / Employer: /UNIT Phone: ( ) - *Reference Information/Emergency Contact (Required): Name of relative/ personal friend not living at residence: Phone Address: City: State: Zip:
CO-APPLICANT INFORMATION. ⮚ Is there a Co-Applicant for this property? (YES / NO) ⮚ Name of Co-Applicant: Each Applicant must fill out and sign a separate Lease Agreement Application form and pay a non- refundable $35 application fee for the background verifications. Checks must be payable to Advance Links LLC. Alternatively, each Applicant may send payment electronically to PayPal at xxxxxxxxxxxx@xxxxx.xx.xxx or to Venmo at Xxxxxxxx-Xxxxxx
CO-APPLICANT INFORMATION. Your spouse is NOT presumed to be a Co-Applicant. They MUST be added and present an I.D. at application time. No information will be shared unless they are on this application! -Co-Applicant Name: First: Last: Employer: /UNIT Phone: *Reference Information/Emergency Contact (Required): Name of relative/ personal friend not living at residence: Phone Address: City: State: Zip: ANSWER THE FOLLOWING QUESTIONS: *Would you like to go ‘paperless’ with your xxxx? This option is available and will require your email address; if you choose YES, you will NOT get a paper xxxx mailed. At this time ‘both’ US Mail and Email is not an option. Your email address is only available to the City of St. Xxxxxx and will not be made available to anyone else. It is considered confidential information along with all information on this application. At no time will the City of St. Xxxxxx ask you for personal information, social security number, or bank information electronically, over the telephone. Check One: YES NO (WRITE CLEARLY) EMAIL ADDRESS: *HAS ANYONE IN THE RESIDENCE HAD PRIOR SERVICES WITH THE CITY? [ ] YES OR [ ] NO *CAN DETAILS ABOUT THIS ACCOUNT BE LEFT ON YOUR VOICE MAIL MESSAGE SYSTEM: Yes or NO *WOULD YOU LIKE TO BE SET UP ON DIRECT BANK WITHDRAW? { } Yes { } No IF YOU DO: Bank Name: Account #: Routing #: { } Checking { } Savings Signature of Applicant: Date: Signature of Co-Applicant: Date: _
