General Information Ancora Properties Applicant Information First Name Last Name SSN Cell Phone Age Date of Birth Gender MaleFemale Work Phone Email Address Present Address Street City State Zip Driver’s License Number Present Landlord Landlord Phone Monthly Rent How long there? Reason for Leaving EvictionsHave you ever been evicted, sued for nonpayment of rent, breached a lease, failed to make any rent payments? (if so, explain) Have you ever been arrested or convicted of a crime? YesNoIf yes, explain Occupants Fill names of all individuals (and ages of all children) who will occupy premises other than you: First Name Last Name First Name Last Name First Name Last Name First Name Last Name First Name Last Name First Name Last Name Pets (Specify Type) Employment Present Employer Supervisor Street City State Zip Phone Occupation Start Date Monthly Income Automobiles Make/Model Year Plate No. State Make/Model Year Plate No. State Make/Model Year Plate No. State Make/Model Year Plate No. State Financial Other Income $ Monthly Source Emergency Contact Full Name Phone Relationship Notes IMPORTANT CERTIFICATION: (All deposits and fees paid with this application are non-refundable) I certify that the above information is true, accurate, and complete. Ancora Properties is authorized to verify this information by contacting any or all individuals, financial institutions, and other contacts as provided herein including a credit profile check, criminal and general background check, rental history (eviction) check, and other investigations that may be necessary. I understand that this is not a lease and that no binding obligation of any kind exists between the owner and/or Ancora Properties and myself unless and until a lease is properly executed. I understand that Ancora Properties will incur costs in processing this information and that the application fee is not refundable. IMPORTANT: Typing your name below is the same as signing this document Signature of Applicant Date Type the characters you see in the picture without using spaces Invalid CAPTCHA. Please try again.