Rental Application
First Name:                                     Last name:

Street Address:                                           Phone:

City:                                    State:                  Zip:

Date of Birth:                     Drivers License Number:


Have you ever been arrested: 
(Please be truthful, an arrest will not disqualify you but dishonesty will)

Please Explain:

Have you ever been evicted:
(Same Deal)

Please Explain:
A Division of New Life Recovery Project Inc.