Submit Application for Cozy Pines 2 Bed Basement Apartment 252 E 2nd N, Rexburg, ID, 83440 $1,300/mo 1,400 sq ft 2 bed 1 bath Applicant Contact First Name Last Name Email Address Phone Number Residence History Current Address City State Zip Code Rent or Own Select oneRentOwnOther Monthly Payment Move-In Date Lease Expires Landlord Name Landlord Phone Reason for Leaving Co-Applicant Residence HistoryComplete this section only if another applicant will be on the lease. Co-Applicant Current Address Co-Applicant City Co-Applicant State Co-Applicant Zip Code Co-Applicant Rent or Own Select oneRentOwnOther Co-Applicant Monthly Payment Co-Applicant Move-In Date Co-Applicant Lease Expires Co-Applicant Landlord Name Co-Applicant Landlord Phone Co-Applicant Reason for Leaving Employment Information Current Employer Position Supervisor Employer Phone Employer Address Employer City Employer State Employer Zip Code Employment Start Date Employment End Date Leave blank if this is your current position. Gross Monthly Income Additional Income Sources Public Assistance Select yes or noYesNo Public Assistance - Explain Social Security Select yes or noYesNo Social Security - Explain Disability Select yes or noYesNo Disability - Explain Child Support Select yes or noYesNo Child Support - Explain Alimony Select yes or noYesNo Alimony - Explain Other Income Select yes or noYesNo Other Income - Explain Vehicles Vehicle 1 - Year Vehicle 1 - Make Vehicle 1 - Model Vehicle 1 - Color Vehicle 1 - Tag # Vehicle 1 - State Vehicle 2 - Year Vehicle 2 - Make Vehicle 2 - Model Vehicle 2 - Color Vehicle 2 - Tag # Vehicle 2 - State Any Other Vehicles Pets Pet 1 - Type Pet 1 - Breed Pet 1 - Weight Pet 1 - Fixed? Select yes or noYesNo Pet 2 - Type Pet 2 - Breed Pet 2 - Weight Pet 2 - Fixed? Select yes or noYesNo Pet 3 - Type Pet 3 - Breed Pet 3 - Weight Pet 3 - Fixed? Select yes or noYesNo Pet 4 - Type Pet 4 - Breed Pet 4 - Weight Pet 4 - Fixed? Select yes or noYesNo Emergency Contacts Emergency Contact 1 - Name Emergency Contact 1 - Relation Emergency Contact 1 - Phone Emergency Contact 1 - Email Emergency Contact 2 - Name Emergency Contact 2 - Relation Emergency Contact 2 - Phone Emergency Contact 2 - Email Screening Questions Eviction Select yes or noYesNo Landlord Balance Select yes or noYesNo Lease Violation Select yes or noYesNo Bankruptcy Select yes or noYesNo Felony Select yes or noYesNo Misdemeanor Select yes or noYesNo Question Explanations Applicant Signature Details I understand that checking this box and submitting this application constitutes my electronic signature and is the legal equivalent of my handwritten signature. Printed Name of Applicant Applicant Date Printed Name of Co-Applicant Co-Applicant Date Submit Rental Application