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Lease Application

Email Address:
What Property Are You Interested In (if known):

Applicant's Name:
D.O.B		Home #
		Cell #

Spouse's Name:
D.O.B

Present Address
Zip Code:
Landlord:		Landlord Phone:
Landlord Address

OTHER PERSONS THAT ARE TO OCCUPY THE PREMISES APPLIED FOR:

Name:

Relationship:

D.O.B.

Name:

Relationship:

D.O.B.

Name:

Relationship:

D.O.B.

Name:

Relationship:

D.O.B.

APPLICANT EMPLOYMENT:

Employed By:

Position:

How Long:

Gross Monthly Income:

Business Address:

Supervisor's Name:

Supervisor's Phone::

SPOUSE EMPLOYMENT:

Employed By:

Position:

How Long:

Gross Monthly Income:

Business Address:

Supervisor's Name:

Supervisor's Phone::

PERSON TO NOTIFY IN CASE OF EMERGENCY:

Name:

Relationship:

Phone:.

Address

Do You Have Pets:

Pet Type:

Have you ever been evicted?

If "YES" give details:

Have you ever been convicted of a felony?

If "YES" give details:

By Checking This Box, I Hereby Digitally Sign This Form

Re-type Name:

Jim Russell Properties, LLC
P. O. Box 91645
Louisville, Ky 40291
(502) 494-8100
jimrussell48@gmail.com
Fax: (502) 416-0545

Privacy Statement: Your privacy is important to those of us at Jim Russell. For this reason, the information you provide us above will only be used by Jim Russell. It is our policy to NEVER sell or give this information to any company, organization, or individual - period!