Parkway Place
3040 Bennett Lane * Melbourne, FL 32935
Office (321) 757-7900
Fax (813) 925-4287

RENTAL APPLICATION
Desired Community Name _____________________________________ Desired Move-in Date ____ /____/20_____
Desired Apartment Size (check one) 1BR

2 BR

3 BR

4 BR

To be filled out by Applicant only. Complete all fields or list NONE. Please Print. Circle Yes or No where applicable. All Applicants over 18 years of age must complete a separate application. (USE BLACK INK
ONLY)

Applicant Information
Applicant Name: Last ________________________________ First __________________________ MI _____________________
Social Security # ______________________________ Driver’s License # _____________________________________ State ____
Phone ( ___ ) _____ - ____________ Cell Phone ( ___ ) ____ - _______________ Email __________________________________

Apartment Occupants
List all dependents and other persons including absent household and unborn members that will be living (50% of the leasing period) in the apartment.
Relationship to
Student
If Student,
Household member name
Head of
Birth Date
Age
Gender
Y or N
Full-Time or
Household
Part-Time
Head of Household

Do you have custody of all minors (17 and under) listed above?

Yes

No

None

“Will all of the persons in the household be or have been full-time students during five calendar months of this year or plan to be in the next calendar year at an educational institution (other than a correspondence school) with regular faculty and students?”

Yes

No

If yes, the full name of the institution attending: ____________________________.

Do you anticipate any changes in the household composition in the next 12 months?

Yes

No

If yes, what is the change: ___________________________ and when is it expected to occur: ______________________

Residential Information / Employment / Income History (MUST PROVIDE 2 YEARS OF RESIDENTIAL HISTORY)
Current Address _____________________________________ __________ __________________ _____ _________
Street
Apt #
City
State
Zip
Length of Occupancy: From ___________ To ____________ Do you: Own Rent Family
Monthly Payment $_______
Community/Landlord________________________________________________ Phone ( ____ ) _______ - __________
Previous Address_____________________________________ __________ __________________ _____ _________
Street
Apt #
City
State
Zip
Length of Occupancy: From ___________ To ____________ Do you: Own Rent Family Monthly Payment $_______
Community/Landlord________________________________________________ Phone ( ____ ) _______ - __________
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Present Employer_________________________________________ Position _______________________________
Employer’s Local Address ____________________________ _________ __________________ _____ _________
Street
Suite #
City
State
Zip
Phone ( ____ ) _____ - _______________ FAX ( ____ ) _____ - _________________
Date employed from: __________________ Gross: Wkly Bi-Wkly
Other Current employment: Yes

Bi-Mthly Mthly

Salary $______________

No

If yes, Other Employer _________________________________ Position ____________________________________
Employer’s Local Address ____________________________ _________ __________________ _____ _________
Street
Suite #
City
State
Zip
Phone ( ____ ) _____ - _______________ FAX ( ____ ) _____ - _________________
Date employed from: __________________ Gross: Wkly Bi-Wkly

Bi-Mthly Mthly

Salary $______________

Previous Employer_______________________________________ Phone ( ____ ) _____ - _______________
Dates employed: From _______ To _________ Gross:

Wkly

Bi-Wkly

Bi-Mthly

Mthly

Salary $______________

Other Sources of Income
Do you receive or have you been awarded (for yourself or on behalf of someone else) any of the following?
Check Box
List How It Is Received
Income Source
$ Amount Received
Yes