Residential Leasing Application

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.

SSN#

Marital Status

Co-Applicant?

Yes

No

Co-Applicant

First MI Last

Age

Phone

D.O.B.

SSN#

Marital Status

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 Country

Phone

OTHER INFORMATION

Interested In

Apartment

Duplex

Mobile Home

Applicant's Signature*

Co-Applicant's Signature

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

Signature*

Social Security Number

Date of Birth

Other names used by me:

Current Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Co-Applicant

Date

Signature*

Social Security Number

Date of Birth

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.

Applicant's Signature

Date

Co-Applicant's Signature

Date

Phone

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