TENANT APPLICATION FORM
For: Strombeck Properties
Brookside, Meadowbrook, Parkway, Woodridge, Hidden Grove, Twin Parks & Westwood Garden Apartments
Phone: 707-822-4557 | Fax: 707-822-4525 | Application Date:
Note: Each person over the age of 18 who will be residing in (or co-signing for) the unit is required to submit a separate application and pay the nonrefundable
$40.00 fee
.
I agree
APPLICANT
NUMBER OF BEDROOMS APPLYING FOR
» select
1
2
3
4
LAST NAME
FIRST NAME
MI
SOCIAL SECURITY NUMBER
-
-
DATE OF BIRTH
/
MM
/
DD
YYYY
PLEASE PROVIDE AT LEAST ONE OF THE FOLLOWING:
Home Phone
Work Phone
Cell Phone
HOME PHONE
(
)
-
WORK PHONE
(
)
-
CELL PHONE
(
)
-
EMAIL ADDRESS
DO YOU HAVE A DRIVER'S LICENSE?
No
Yes
If you obtain a driver's license, please report this to our office immediately.
DRIVER'S LICENSE #
STATE LICENSED
» select state
Alabama
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
DO YOU HAVE A VEHICLE?
No
Yes
If you obtain a vehicle, please report this to our office immediately.
VEHICLE LICENSE #
VEHICLE DESCRIPTION
ADDITIONAL OCCUPANTS
FULL NAME
RELATIONSHIP
AGE
OCCUPATION
FULL NAME
RELATIONSHIP
AGE
OCCUPATION
FULL NAME
RELATIONSHIP
AGE
OCCUPATION
RENTAL HISTORY
Currently renting
Current homeowner
No current rental history
CURRENT ADDRESS
CITY
STATE
»
Alabama
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
LANDLORD/MANAGER
PHONE
(
)
-
DATES
OCCUPIED
FROM
/
MM
/
DD
YYYY
TO
/
MM
/
DD
YYYY
PLEASE SELECT YOUR RECENT RENTAL HISTORY...
Recently rented
Recent homeowner
No recent rental history
RECENT ADDRESS
CITY
STATE
»
Alabama
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
LANDLORD/MANAGER
PHONE
(
)
-
DATES
OCCUPIED
FROM
/
MM
/
DD
YYYY
TO
/
MM
/
DD
YYYY
PLEASE SELECT YOUR PREVIOUS RENTAL HISTORY...
Previously rented
Previous homeowner
No previous rental history
PREVIOUS ADDRESS
CITY
STATE
»
Alabama
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
LANDLORD/MANAGER
PHONE
(
)
-
DATES
OCCUPIED
FROM
/
MM
/
DD
YYYY
TO
/
MM
/
DD
YYYY
EMPLOYMENT STATUS
Currently Employed
Currently Unemployed
OCCUPATION
EMPLOYER
ADDRESS
CITY
STATE
»
Alabama
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
SUPERVISOR'S NAME
SUPERVISOR'S PHONE
(
)
-
LENGTH OF
EMPLOYMENT
(approximate)
,
YEARS
,
MONTHS
DAYS
ANNUAL INCOME
$
HOUSEHOLD INCOME INFORMATION
1. YOUR GROSS MONTHLY INCOME (BEFORE DEDUCTIONS)
$
2. AVERAGE MONTHLY AMOUNTS OF OTHER INCOME...
a. ARE YOU RECEIVING AFDC/PUBLIC ASSISTANCE?
No
Yes
$
b. ARE YOU RECEIVING UNEMPLOYMENT?
No
Yes
$
c. ARE YOU RECEIVING FOOD STAMPS?
No
Yes
$
d. ARE YOU RECEIVING CHILD SUPPORT?
No
Yes
$
3. OTHER MONTHLY INCOME (SPOUSE, ETC...)
$
4. TOTAL MONTHLY HOUSEHOLD INCOME (SUM OF LINES 1, 2 & 3)
$
5. TOTAL GROSS YEARLY INCOME (MULTIPLY LINE 4 x 12)
$
STUDENT INCOME INFORMATION
1. ARE YOU RECEIVING FINANCIAL AID?
No
Yes
$
Per Month
Per Year
Per Semester
2. ARE YOU RECEIVING ANY GRANTS?
No
Yes
$
Per Month
Per Year
Per Semester
3. ARE YOU RECEIVING MONEY FROM YOUR PARENTS?
No
Yes
$
Per Month
Per Year
Per Semester
4. TOTAL MONTHLY STUDENT INCOME (SUM OF LINES 1, 2 & 3)
$
MISCELLANEOUS
DO YOU HAVE OR INTEND TO HAVE LIQUID FURNITURE?
(fish tanks, water beds, etc...)
No
Yes
Please describe.
characters available
90
DO YOU HAVE ANY ANIMALS?
(dog, cat, snake, etc...)
No
Yes
Please describe.
characters available
90
DO YOU SMOKE?
No
Yes
Inside
Outside
HAVE YOU, OR ANYONE WHO WILL RESIDE WITH YOU ON THE COMPLEX, EVER BEEN CONVICTED OF A FELONY?
No
Yes
What was the conviction?
characters available
180
HAVE YOU EVER:
FILED FOR BANKRUPTCY?
No
Yes
Please explain.
characters available
270
BEEN SUED?
No
Yes
Please explain.
characters available
270
BEEN EVICTED?
No
Yes
Please explain.
characters available
270
EMERGENCY CONTACT
NAME
RELATIONSHIP
PHONE
(
)
-
ADDRESS
CITY
STATE
»
Alabama
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
ALTERNATE EMERGENCY CONTACT
NAME
RELATIONSHIP
PHONE
(
)
-
ADDRESS
CITY
STATE
»
Alabama
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
PHOTO ID
You can attach a digital picture of your photo ID to this form, or if you prefer, mail a copy directly to the Strombeck Properties office at PO Box 37, Eureka, CA 95502.
Choose Photo
*.jpg/jpeg or .heic/heif < 10MB
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PAYMENT
Strombeck Properties utilizes 256-bit Private SSL encryption, to safeguard your personal data, the same level of protection used in commercial bank transactions. You can enter your payment details below, or if you prefer, mail your check or money order directly to the Strombeck Properties office at PO Box 37, Eureka, CA 95502. You can also call our office at 707-822-4557 to submit credit card information over the phone.
Enter Payment Details Now
I Will Arrange Payment Separately
CARD TYPE
» select
Visa
MasterCard
NAME ON CARD
CARD NUMBER
EXPIRATION DATE
/
MM
/
DD
YYYY
VERIFICATION NUMBER
(Last three digits displayed in the signature panel on the back of your card.)
SIGNATURE
This form contains advanced technology to capture a highly responsive hand-written signature directly from your device. Using your left mouse button or touch-enabled screen, lift and drag the cursor across the pad below. Click "Clear" to redo and "Save" when complete. Your signature is required and will be attached to this application.
I CERTIFY THAT ALL INFORMATION GIVEN ABOVE IS TRUE AND CORRECT AND UNDERSTAND THAT MY LEASE OR RENTAL AGREEMENT MAY BE TERMINATED IF ANY MISREPRESENTATION IS FOUND IN THIS APPLICATION. I AUTHORIZE VERIFICATION OF ANY GIVEN INFORMATION AND REFERENCES PROVIDED IN THIS APPLICATION. I UNDERSTAND THIS APPLICATION WILL BE RETAINED FOR THREE MONTHS, REGARDLESS OF APPROVAL. STROMBECK PROPERTIES DOES NOT STORE THE CONTENTS OF THIS FORM IN AN ONLINE DATABASE, AND DOES NOT SET HTTP COOKIES IN YOUR WEB BROWSER. ALL INFORMATION IS CLEARED FROM LOCAL STORAGE, IF YOUR WEB BROWSER SUPPORTS THIS PROTOCOL, ONCE THIS FORM IS SUBMITTED. IN ADDITION TO ALL SUMS DUE PRIOR TO OCCUPANCY,
I AGREE TO PAY A NON-REFUNDABLE FEE OF $40.00, WHICH SHALL BE USED TO OBTAIN A REPORT OF MY CREDIT FROM A CREDIT REPORTING AGENCY.