This form is being sent through our secure website. Your information is protected. Please read carefully and fill in all information. If a particular field does not pertain to you, enter "NONE" or "N/A". Just hover your mouse over the little blue "i" for additional help.

* Enter your full name.
* Enter your social security number.
* Enter your driver's license number.
* Enter your date of birth as mm/dd/yyyy
* An email address is required for confirmation.
List other occupants and their relationship to the applicant. If there are no other occupants, enter none or n/a
 
 
* Enter the name of the first additional occupant. If this does not apply to you then enter none or n/a
* If this does not apply enter none or n/a
* If this does not apply enter none or n/a
* If this does not apply enter none or n/a
* Enter the name of the 2nd additional occupant. If this does not apply enter none or n/a
* If this does not apply enter none or n/a
* If this does not apply enter none or n/a
* If this does not apply enter none or n/a
* Enter the name of the 3rd additional occupant. If this does not apply enter none or n/a
* If this does not apply enter none or n/a
* If this does not apply enter none or n/a
* If this does not apply enter none or n/a
 
 
* Please enter your current address.
* Enter the name of the owner of your current address.
* Enter the phone number of owner of current address.
* Enter the months or years you have resided at your current address.
* Enter the amount in US dollars.
* Please give a brief explanation for leaving current address.
 
 
* Please enter your previous address.
* Please enter the name of the owner of your previous address.
* Enter the phone number of the owner of your previous address.
* Enter the months or years at previous address.
* Enter rent amount in US dollars.
* Give a brief explanation for leaving previous address.
 
 
* List your current employer. If you are receiving SSI enter the amount and a proof of income will be required.
* Please enter a contact number for your employer.
* Enter your hire date. If you receive SSI enter the date you began receiving it.
* Enter your wages in US dollars. If you are receiving SSI enter amount, you will be required to show proof of income.
* Enter weekly, bi-weekly, monthly or however often you are paid.
* Enter number hours worked each week. If this does not apply to you enter "NONE" or "N/A"
 
 
* You must answer yes or no.
* If you answered yes tell us what the pet is and how much it weighs. If you answered NO then enter N/A
* You must answer yes or no.
* If you answered yes, give a brief explanation for the lease break or eviction. If you answered NO, then enter N/A
* You must answer yes or no.
* If yes, please give a brief description of circumstances. If no, enter n/a.
* You must answer this question yes or no.
* Give a brief description of the circumstances. If no, enter n/a
Please enter your automobile information below.
(Make, model, color, year, license plate number and state of registration.)
* Please enter the Make of your vehicle. If you do not have an automobile, enter n/a.
* If you do not have an automobile, enter n/a.
* Example Burgandy over beige. If you do not have a vehicle, enter n/a
* Enter the manufacture year. If you do not have a vehicle, enter n/a
* Enter your vehicle's license plate number.
* Select the state the vehicle is registered in. If you do not have a vehicle select Kansas.
* Enter the make of a second vehicle. If you do not have one enter n/a.
* Enter the model of second vehicle or n/a.
* Enter color of second vehicle or n/a.
* Enter the model year of second vehicle or n/a.
* Enter license plate number for second vehicle or n/a.
* Select the registered state for the second vehicle or n/a.
 
 
* Enter the name of someone we may contact in the event of emergency.
* Enter the address of the first emergency contact.
* How is this contact related to you?
* Enter a phone number for this person.
* Enter the name of an alternate contact person we can contact in the event of an emergency.
* Enter the address of this second person or n/a.
* How is this second person related or n/a.
* Contact two phone number or n/a.
If the management and/or its agents have any questions about this application, please give phone numbers where you can be reached.
* Enter the best or easiest phone number where you can be reached.
* Enter a second number or n/a.
* Enter third ohone number or n/a.
I authorize The Vineyard Townhomes and / or its agent to examine my credit history. I certify that the above information is correct, and I understand that this application may be revoked if any information furnished is found to be incorrect. I hereby grant this property and / or its agent the right to process this application for the purpose of obtaining a Rental / Lease agreement with this property. Additionally, I authorize all current and former employers to release information they may have about me and release them from any liability and responsibility from doing so.
If I submit a deposit of $375.00 for a one bedroom or $400.00 for a two bedroom, I understand that it is refundable if this application is denied. If the reservation is canceled for any reason within three (3) calendar days from the date the deposit is given to a representative of Vineyard Townhomes, I agree to forfeit $50.00. If the reservation is canceled for any reason in four (4) or more calendar days, I agree to forfeit the full deposit paid.
* You must agree to above terms before submitting the form.
WE DO BUSINESS IN ACCORDANCE WITH THE FEDERAL FAIR HOUSING LAW, IT IS ILLEGAL TO DISCRIMINATE AGAINST ANY PERSON BECAUSE OF RACE, COLOR, RELIGION, SEX, HANDICAP, FAMILIAL STATUS, OR NATIONAL ORIGIN.
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