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Residential Leasing Application
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Residential Leasing Application
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THE UNDERSIGNED makes application for occupancy in a Drury Southwest, Inc. managed residential unit. This apartment project is designed for people who want a nice place to live. Parties or other such activities will not be tolerated and the tenant will be asked to leave. Pets are not allowed. Please complete this application in full. All information is kept confidential. The undersigned verifies the following facts are true and authorizes Drury Southwest to check all information as it shall deem necessary to determine the undersigned's financial and credit standing and moral character.
How did you find out about our community?
Intended Length of Occupancy
PERSONAL DATA
Applicant
First
MI
Last
Age
Phone
D.O.B.
MM slash DD slash YYYY
SSN#
Marital Status
Married
Single
Divorced
Widowed
Co-Applicant?
Yes
No
Co-Applicant
First
MI
Last
Age
Phone
D.O.B.
MM slash DD slash YYYY
SSN#
Marital Status
Married
Single
Divorced
Widowed
Applicant Email
Co-Applicant Email
Name, Birth dates and Ages of Children
Have your ever been evicted from any leased premises?
Yes
No
Explain
Present Home Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
How Long?
Monthly Rental
Landlord's Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Reason for Moving
Previous Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
EMPLOYMENT INFORMATION
Applicant's Employer
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
How Long?
Title
Gross Monthly Wages
Immediate Supervisor
Phone
Previous Employer
How Long?
Co-Applicant's Employer
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
How Long?
Title
Gross Monthly Wages
Immediate Supervisor
Phone
Previous Employer
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
How Long?
CREDIT REFERENCES
Name of Bank
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Checking Account#
Contact
Personal Reference 1
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Personal Reference 2
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Nearest Relative Not Living with you
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Phone
OTHER INFORMATION
Interested In
Apartment
Duplex
Mobile Home
Applicant's Signature
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Co-Applicant's Signature
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AUTHORIZATION TO RELEASE INFORMATION
TO WHOM IT MAY CONCERN:
1. I/We have made application to lease/purchase property from:
Drury Southwest, Inc.
Weiss Park, Inc,
As part of the application approval process, said company or its duly authorized agents may verify information contained in the application and in other documents, both before and after the transaction is completed. 2. I/We authorize said company, or its duly authorized agents, to obtain any information or documentation at any time regarding my employment, history and income, debts, credit history, checking and/or saving accounts, and ll other credit matters. 3. I/We hereby direct you to release such information upon the request of the holder of this document. I release any individual from liability for damages that may result on account of their compliance with this authorization. 4. The holder of this document may address this authorization to anyone possessing such information. 5. A copy of this authorization may be deemed to be the equivalent of the original and may be used as a duplicate original.
Applicant
Date
MM slash DD slash YYYY
Signature
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Social Security Number
Date of Birth
MM slash DD slash YYYY
Other names used by me:
Current Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Co-Applicant
Date
MM slash DD slash YYYY
Signature
*
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Social Security Number
Date of Birth
MM slash DD slash YYYY
Other names used by me:
Current Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
To: Customers and Consumers of Weiss Park, Weiss Park, Inc., Weiss Park, Inc. d/b/a/ DMart Homes and/or Drury Southwest, Inc.
PRIVACY POLICY of WEISS PARK, DMART HOMES and DRURY SOUTHWEST, INC.
What this Privacy Policy Covers
This Privacy Policy covers Weiss Park Manufactured Home Community, Weiss Park, Inc., Weiss Park, Inc d/b/a DMark Homes and Drury Southwest, Inc.'s (collectively, "we/our/us") treatment of nonpublic personally identifiable information that we collect when you, the "customer" or "consumer," purchase a manufactured home, finance the purchase of a manufactured home and/or apply to rent a duplex, apartment, lot or lot and home from us. This policy also covers our treatment of any nonpublic personally identifiable information that our business partners share with us.
This policy does not apply to the practices of non-affiliates of Weiss Park Manufactured Home Community, Weiss Park, Inc., Weiss Park, Inc. d/b/a DMart Homes or Drury Southwest, Inc.
Information Collection and Use
We collect nonpublic personal information about you from the following sources:
information we receive from you on applications or other forms;
information about your transactions with us, our affiliates, or others; and
information we receive from a consumer reporting agency.
Information Sharing and Disclosure
We do not disclose nonpublic personal information about you to anyone, except as permitted by law.
Confidentiality and Security
We restrict access to nonpublic personal information about you to those employees and third party vendors and service providers who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal standards to guard your nonpublic personal information. By signing below, I acknowledge that Weiss Park, Weiss Park, Inc., Weiss Park, Inc. d/b/a DMart Home and/or Drury Southwest, Inc., provided me with a copy of its Privacy Policy.
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Date
MM slash DD slash YYYY
Co-Applicant's Signature
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Date
MM slash DD slash YYYY
Phone
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