List all persons to occupy Apartment: Only those listed on this application shall occupy apartment.

Have you ever left owing Rent?

Have you ever been evicted?

Have you ever been convicted of a felony?




Do you have a pet? -

Do you own Real Estate? -

Person to be notified in the event of emergency:

I (we) hereby apply for occupancy of apartment no._____ located at ________________ and agree to take the premises and execute an apartment lease in form used by the Owner.

I (we) hereby make an earnest money deposit of $175.00 which is to be forfeited and retained by the Owner if balance of deposit, equaling $_________ is not paid by the due date.  (Due date is 10 days after selection of an apartment or before move-in date, whichever occurs first.)  If this application is NOT accepted, or if I (we) cancel the application within 3 days of application, the earnest money deposit will be refunded within 30 days of application.  The Owner will retain the credit check fee.

I (we) acknowledge that the selection of an apartment will cause the Owner to remove that apartment from the market, so that if I (we) fail to occupy the apartment, the Owner will incur monetary damages which are certain to occur but difficult to calculate.  Therefore, if I (we) fail to occupy the apartment, the entire amount of this deposit shall be considered liquidated damages and shall be retained by the Owner.  If I (we) occupy the apartment, the entire amount of this deposit shall be converted to the security deposit required under the lease.

I (we) represent that all of the above statements are true and correct and hereby consent to allow PCRM, Inc., through its designated agent and its employees, to obtain and verify my credit information including a criminal background search for the purpose of determining whether or not to lease me/us an apartment.  I (we) understand that should I (we) lease an apartment, PCRM, Inc. and its agent shall have a continuing right to review my credit information, rental application, criminal background, payment history and occupancy history for account review and collection purposes.  I (we) understand that falsifying of information on the application will be grounds for rejection of tenancy.

By clicking on the submit button, you and anyone named in this application agree to the terms and conditions of this application including our Resident Selection Criteria.

Revised 04/17/2018