Montara Leasing - Home
7105 SW Montara Parkway
Topeka, KS 66619
785-862-1030

APPLICATION

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FREE ONLINE APPLICATION
Please fill out completely. Failure to complete this application in full, including daytime phone
numbers, will seriously delay completion of this application.
FIELDS MARKED WITH * ARE REQUIRED
Part I - Personal Information
Today is:
* Desired Date of Occupancy
* Name
* Date of Birth 19 * Social Security Number
* Email Address
* Marital Status | * Date of divorce or separation
* Spouse's Name
* Spouse's DOB 19 * Spouse's Social Security Number
* Phone # you can be reached Other Phone # (if applicable)
* No. of occumpants – Adults: Children: Name of child occupant | Age
Name of child occupant | Age Name of child occupant | Age
In case of emergency notify:
Phone
* Have you ever been convicted of or pleaded guilty or "no contest" to a felony
(whether or not resulting in a conviction)?
* Have you ever been convicted of or pleaded guilty or "no contest" to a misdemeanor involving sexual misconduct
(whether or not resulting in a conviction)?
Part II - Residence History
A. * Present Address
* Spouse's Address
* Present Landlord * Phone # Fax #
* Rent Amount $ | * From: * To:
B. Previous Address
Previous Landlord Phone # Fax #
Rent Amount $ | From: To:
C. Previous Address
Previous Landlord Phone # Fax #
Rent Amount $ | From: To:
Part III - Employment and Bank References
A. * Employed By * Phone # Fax #
* Address
* Position * Approx. Mo. Income $
B. * Spouse's Employment * Phone # Fax #
* Address
* Position * Approx. Mo. Income $
C. Bank Reference Phone #
Address
Account # Checking | Savings
D. Other Income
Part IV - Character References
Name Phone #
Name Phone #
Part V - Automobile Information
Drivers Lic. #
Car Make Year License
Car Make Year License
* By checking this box, you declare that all of your responses are true and complete and authorize Montara LLC to verify this information. Inquries that may be requested but not limited to Credit Report, Rental and Employment history Any false statement on this application can lead to rejection of your application or immediate termination of your lease.
A signature must be on file before occupancy.
* Indicates a required field.