Application To Rent

Apartment No./House _____________ at ____________________________, ___________, Illinois

Commencing _______________ Ending _______________ Occupancy Date _______________

Monthly Rent  $ ___________________  Damage Deposit $ __________________ .

Applicant  _____________________________ Birth Date  _____________________________ Driver's Lic NO. _________________________ Soc. Sec # _____________________________ Car License (State) _____  No. ____________ How many will occupy premises  ________	Present Address _________________________  City ____________  State _____ Zip _________  Phone __________________________________ How Long? ---------------------------------  Rent $_______ Present Landlord _________________________ Address _________________  Phone_________
Nearest Relative (parents) : Name(s) ________________________________ Address ________________________________ City _______________  St_______ Zip________ Phone (Area Code &  #)______________________  Have you been evicted as a tenant?______	Present Employer ________________________ Address ________________________________ Phone ______________  Position ___________ Salary ________wk/mo, Years Service _____ Bank Reference  (Name) _________________ City _______________________  State _______

            I declare the above application information to be true under penalty of perjury and agree that Lessor may immediately terminate any tenancy entered into in reliance upon misinformation given on this application.  I hereby tender the sum of  $______________ as consideration to thereby induce Lessor to rent said premises to me.  I agree to lease said premises on the terms stated in the Lease, a copy of which I  have read, and agree that in the event I have been accepted, and I do not sign or execute said Lease or do not move in to the premises, ANY PAYMENTS MADE HEREWITH WILL BE DUE AND SHALL BE FORFEITED AS LIQUIDATED DAMAGES  since  (1)  other prospective tenants will have been turned away,

(2) it  will be necessary for Lessor to re-advertise the property,  (3)  it will be necessary for Lessor to re-evaluate other prospective tenants, and  (4)  since Lessor agrees not to rent premises during the pendency of this application to other prospective tenants.    If said premises are not ready for occupancy for any reason, the Lessor shall not be liable, but rent shall be abated and the  commencement date  postponed until the Lessor deems the premises are ready for occupancy.  If any application is not accepted within 30 days hereof, I will be notified and all payments will be returned in full.

Applicant _________________________________________   Date _________________________

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