65 Bentley Avenue

Whitesburg, KY 41858

(606) 632-1717

Homes, Inc.

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Preliminary Rental Application

Please fill out all sections accurately and completely. A HOMES staff person will gladly assist you upon request.

I. Applicant Information

Applicant Name

First Name

Last Name

Email Address

Address

Phone

(###)

###

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II. Household Member Information: List all persons who will live in the unit beginning with the applicant.

Name each person and relationship to applicant on a new line.

III. Please provide all income/earning information for all household members.

Total income for household

Annually/Monthly

IV. Personal References: Please provide the names & phone numbers of 1-2 persons in a position of authority and good standing in the community who could vouch for your personal character. These persons cannot be a family member or close personal friend.

Name

First Name

Last Name

Phone

(###)

###

####

Name

First Name

Last Name

Phone

(###)

###

####

V. Present & Previous Residence Information for the past 3 years.

Landlord Name

First Name

Last Name

Phone

(###)

###

####

Move-In Date

YYYY

Move-Out Date

YYYY

Monthly Rent Amount

Landlord Name

First Name

Last Name

Phone

(###)

###

####

Move-In Date

YYYY

Monthly Rent Amount

Move-Out Date

YYYY

Additional Comments