RENTAL APPLICATION 


APPLICANT		

Applying For Apt./Unit No.:  _______________________________________________________
      					
NAME:  _____________________________________		SOCIAL SECURITY#:  ________________________________
                 (First, Middle Initial, Last)

DATE OF BIRTH:       /           /         /			HOME PHONE #:  ____________________________________


1) PRESENT ADDRESS:  _____________________________________________________________________________________
		          STREET, CITY, STATE AND ZIP


         HOW LONG AT PRESENT ADDRESS:   _________	PRESENT LANDLORD:  _______________________________	
								           (NAME)

         LANDLORD ADDRESS:  _______________________________________________________________________________
                                                        (STREET, CITY, STATE AND ZIP


         PRESENT LANDLORD PHONE NUMBER:  ____________________________


2) PREVIOUS ADDRESS: ____________________________________________________________________________________
                                           STREET. CITY, STATE AND ZIP)


           HOW LONG AT PREVIOUS ADDRESS:  _________	PREVIOUS LANDLORD:  ______________________________
								              (NAME)

           PREVIOUS LANDLORD ADDRESS:  ____________________________________________________________________
                                                                                (STREET, CITY, STATE AND ZIP)


           PREVIOUS LANDLORD PHONE NUMBER:  ____________________________


MOTOR VEHICLE INFORMATION (include motorcycle & driver i.d.)

1) AUTO YR., MAKE, MODEL, CAR:  _________________________________________________________________________

              LICENSE PLATE:  _________________      STATE:  _____     DRIVER LICENSE:  ______________   STATE:  _____


2) AUTO YR., MAKE, MODEL, CAR:  _________________________________________________________________________

              LICENSE PLATE:  _________________      STATE:  _____     DRIVER LICENSE:  ______________   STATE:  _____



3) MOTORCYCLE YR., MAKE, MODEL, CAR:  ________________________________________________________________

              LICENSE PLATE:  _________________      STATE:  _____     DRIVER LICENSE:  ______________   STATE:  _____






PAGE TWO


OCCUPANT INFORMATION

NAME OF FIRST ADULT:    ___________________________         NAME OF SECOND ADULT:  _______________________


NAME OF THIRD ADULT:  ___________________________          


NAME OF MINOR AND DOB:  ________________________           NAME OF 2ND MINOR AND DOB:  __________________


NAME OF 3RD MINOR AND DOB:  ____________________


REFERENCES

PERSONAL REFERENCE:  __________________________________________________________________________________
                                                   (name, address, telephone number and relationship)

IN CASE OF EMERGENCY  NOTIFY:  ________________________________________________________________________
                                                                        (name, address, telephone number and relationship)


ADDITIONAL INFORMATION

WATERBED?         YES              NO 	          SMOKERS?        YES        NO        	        PETS?       YES       NO  __________
											(type)

REASON FOR MOVING:  ____________________________________________________________________________________


HAVE YOU EVER BEEN EVICTED FROM A RENT PREMISES?          YES         NO

IF YES, WHY?:  ____________________________________________________________________________________________


MILITARY SERVICE?      YES     NO    COMMANDING OFFICER?:______________________   PHONE #:_____________


HAVE YOU EVER WILLFULLY AND INTENTIONALLY REFUSED TO PAY RENT WHEN DUE?:    YES      NO

IF YES, PLEASE EXPLAIN:  _________________________________________________________________________________


HAVE YOU EVER BEEN CONVICTED OF A CRIME?:   YES      NO    

IF YES, PLEASE EXPLAIN:  _________________________________________________________________________________
			(what, where & when)

PURSUANT TO CHAPTER 351A OF THE REVISED STATUTES ANNOTATED OF THE STATE OF NEW 
HAMPSHIRE, THE MANAGEMENT SHALL NOT REFUSE TO RENT AN APARTMENT TO ANY PERSON BECAUSE 
OF AGE, SEX, RACE, COLOR, MARITAL STATUS, PHYSICAL OR MENTAL HANDICAP, RELIGION OR  
NATIONAL ORIGIN, NOR SHALL MANAGEMENT DISCRIMINATE IN THE TERMS OFFEREED OR SERVICES 
RENDERED.   THIS INFORMATION MAY BE USED FOR CREDIT INQUIRIES AND TO FULFILL UTILITY 
COMPANY REQUIREMENTS.   THE UNDERSIGNED WARRANTS AND REPRESENTS THAT THE ABOVE 
STATEMENT IS TRUE.   IF IT IS DETERMINED THAT FALSE INFORMATION HAS BEEN GIVEN, THIS 
APPLICATION WILL BE DENIED.

___________________________________			_________________
CHENEY PROPERTY MANAGEMENT REPRESENATIVE			APPLICANT                 DATE	

A FEE OF $25 IS REQUIRED TO PROCESS THIS APPLICATION AND THE FEE IS NON-REFUNDABLE.


56 Exeter Road	Tel. 603/659-7200
Newmarket, NH 03857	Fax. 603/659-7208
Web Site: www.cheneyne.com