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Applicant Name: (Last)___________________(First)_______________
(Mid. Int)_____
Spouse's Name: (Last)___________________(First)_______________
(Mid. Int)_____
Marital Status: Single _____ Married _____
Social Security # ______________________ Birth
date: _______________________
Driver's License Number: _______________ State:
__________________________
Spouse's Social Security # ___________________ Birth
date: __________________
Spouse's Driver's License Number: _______________________ State:
___________
OCCUPANTS*:
List all proposed occupants for this unit, INCLUDING APPLICANT.
*If dependents are 18 years or older, please list driver's license
or state identification card and social security number on a separate
sheet of paper.
| Name |
Relation
Age |
Name
|
Relation |
Age |
| |
|
|
|
|
| |
|
|
|
|
| |
|
|
|
|
RESIDENCE:
| Present
Address |
|
| Street |
|
| City/State/Zip |
|
| Phone
Number |
|
| Length
of Residence |
|
| Own
or Rent |
|
| Monthly
Amount |
|
| Mortgage/Landlord |
|
| Address |
|
| City/State/Zip |
|
| Phone
Number |
|
| Mortgage
Acct. # |
|
If less than ten (10) years at present address, give previous
addresses, length of residence and previous Mortgage/Landlord
information for 10 years. Use a separate sheet of paper if necessary.
EMPLOYMENT:
Applicant
| Employer |
|
Position Held |
|
| Address |
|
Length of Employment |
|
| City/State/Zip |
|
Yearly Income |
|
| Is your employment subject to lay-off? |
Yes |
|
|
No |
|
Spouse
| Employer |
|
Position Held |
|
| Address |
|
Length of Employment |
|
| City/State/Zip |
|
Yearly Income |
|
| Is your employment subject to lay-off? |
Yes |
|
No |
|
OTHER INCOME:
List other sources of income (including part-time work, pension,
government).
| Description of Income |
Received From |
Monthly Amount |
| |
|
|
| |
|
|
| |
|
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STATEMENT & SIGNATURE
I certify that the information I have given on this application
is true and complete. False and incomplete information
are grounds for disapproval or my application or eviction. I understand
that this information will be used in checking my credit through
a credit agency.
I understand that membership approval is based on: (1) meeting
minimum income requirements, (2) good credit record, and (3) job
and residence stability.
I will not move anything into any dwelling unit of Ash Street
Cooperative until I have been approved by the Cooperative and
completed all transaction.
Signature ________________________________ Date
________________________
Signature ________________________________ Date
________________________
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