Copperleaf LLC
Jason Moll 985-215-2687
Fax 985-662-0083
Lease
Application
Date: ___________________
Application is hereby made to lease premises: _______ West
Lee Hughes Road Hammond LA. 70403
For a term of ______ and ending on the ___________ day of ____________,
20___ For a Monthly rental of $900, and a security deposit of $900 to be paid in full upon occupancy of the above-described
premises. All kitchen appliances furnished renter will need to provide washer & dryer each unit has a washer and dryer
hook up.
A fee of $25 will be charged to process this Application and will be deducted from the Tenant's
first month's rent if application is accepted. This amount is due at the time of application for residency at the
above-described location. If application is not accepted, the Application fee will not be refunded.
Applicant
Name:
___________________Date of Birth: ______________SS#: _________________
Driver's License #: ________________________________State:
___________________
Present Address: _______________________________________How-long: _________
Previous Address:
______________________________________How long: _________
Married? _____Spouse's Name_____________________Children?
____Ages? _______
Phone #:_____________________________Cell #:______________________________
Your Employment
Spouse's Employment
Employer: ________________________ Employer:
___________________________
Employer Address: _________________ Employer Address: ____________________
_________________________________
___________________________________
Supervisor: ________________________ Supervisor: __________________________
Busi.
Ph #: ________________________ Busi. Ph#: ___________________________
How long on Present
Job? ____________ How long on Present Job? ______________
Annual Income: ____________________
Annual Income: ______________________
References
Bank: __________________________________________Phone#: _________________
Personal
Reference: _______________________________Phone#: _________________
Personal Reference: _______________________________Phone#:
_________________
Personal Reference: _______________________________Phone#: _________________
Contact person
(relative): ___________________________Phone#: _________________
The Landlord or Agent to determine whether to
accept this application may use this information. By signing below, you are giving authorization for a Reference ,Criminal
Background check and credit check to be performed.
Signature: ___________________________________________Date:
______________
