Rental Application

First Name:                                     Last name:

Street Address:                                           Phone:

City:                                    State:                  Zip:

Date of Birth:                     Drivers License Number:

E-mail:

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.