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Submitted URL: https://kansaslease.com/
Effective URL: https://form.jotform.com/91726378539168
Submission: On December 02 via api from US — Scanned from DE
Effective URL: https://form.jotform.com/91726378539168
Submission: On December 02 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: form_91726378539168 — POST https://submit.jotform.com/submit/91726378539168
<form class="jotform-form" onsubmit="return typeof testSubmitFunction !== 'undefined' && testSubmitFunction();" action="https://submit.jotform.com/submit/91726378539168" method="post" name="form_91726378539168" id="91726378539168"
accept-charset="utf-8" autocomplete="on" novalidate="true"><input type="hidden" name="formID" value="91726378539168"><input type="hidden" id="JWTContainer" value=""><input type="hidden" id="cardinalOrderNumber" value=""><input type="hidden"
id="jsExecutionTracker" name="jsExecutionTracker" value="build-date-1732722313894=>init-started:1733131435200=>validator-called:1733131435214=>validator-mounted-false:1733131435215=>init-complete:1733131435219"><input type="hidden"
id="submitSource" name="submitSource" value="mounted"><input type="hidden" id="buildDate" name="buildDate" value="1732722313894"><input type="hidden" name="uploadServerUrl" value="https://upload.jotform.com/upload"><input type="hidden"
name="eventObserver" value="1">
<div id="formCoverLogo" style="margin-bottom:10px" class="form-cover-wrapper form-has-cover form-page-cover-image-align-left">
<div class="form-page-cover-image-wrapper" style="max-width:630px"><img src="https://www.jotform.com/uploads/mandinainvestments/form_files/MI%20LOGO.5d0eb0ed85de73.72629936.jpg" class="form-page-cover-image" width="630" height="122"
aria-label="Form Logo" style="aspect-ratio:630/122"></div>
</div>
<div role="main" class="form-all">
<ul class="form-section page-section" role="presentation">
<li id="cid_1" class="form-input-wide" data-type="control_head" data-css-selector="id_1">
<div class="form-header-group header-default">
<div class="header-text httal htvam">
<h2 id="header_1" class="form-header" data-component="header">RENTAL APPLICATION</h2>
<div id="subHeader_1" class="form-subHeader">Every occupant over the age of 18 MUST fill out a separate application (even if married). Please fill out this form COMPLETELY and electronically sign where indicated.</div>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_dropdown" id="id_45" data-css-selector="id_45"><label class="form-label form-label-top form-label-auto" id="label_45" for="input_45" aria-hidden="false"> CITY REQUESTED:<span
class="form-required">*</span> </label>
<div id="cid_45" class="form-input-wide jf-required"> <select class="form-dropdown validate[required]" id="input_45" name="q45_cityRequested" style="width:150px" data-component="dropdown" required="" aria-label="CITY REQUESTED:">
<option value=""></option>
<option value="Towanda">Towanda</option>
<option value="El Dorado">El Dorado</option>
<option value="Augusta">Augusta</option>
</select> </div>
</li>
<li class="form-line jf-required" data-type="control_address" id="id_44" data-css-selector="id_44"><label class="form-label form-label-top form-label-auto" id="label_44" for="input_44_addr_line1" aria-hidden="false"> ADDRESS APPLYING FOR:<span
class="form-required">*</span> </label>
<div id="cid_44" class="form-input-wide jf-required">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_44_addr_line1" name="q44_addressApplying[addr_line1]" class="form-textbox validate[required] form-address-line" data-defaultvalue="" autocomplete="section-input_44 address-line1" data-component="address_line_1"
aria-labelledby="label_44 sublabel_44_addr_line1" required="" value="" maxlength="100"><label class="form-sub-label" for="input_44_addr_line1" id="sublabel_44_addr_line1" style="min-height:13px">Street
Address</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" id="input_44_addr_line2" name="q44_addressApplying[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_44 off"
data-component="address_line_2" aria-labelledby="label_44 sublabel_44_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_44_addr_line2" id="sublabel_44_addr_line2" style="min-height:13px">Street Address
Line 2</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" id="input_44_city" name="q44_addressApplying[city]" class="form-textbox validate[required] form-address-city" data-defaultvalue="" autocomplete="section-input_44 off"
data-component="city" aria-labelledby="label_44 sublabel_44_city" required="" value="" maxlength="60"><label class="form-sub-label" for="input_44_city" id="sublabel_44_city" style="min-height:13px">City</label></span></span><span
class="form-address-line form-address-state-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_44_state"
name="q44_addressApplying[state]" class="form-textbox validate[required] form-address-state" data-defaultvalue="" autocomplete="section-input_44 off" data-component="state" aria-labelledby="label_44 sublabel_44_state" required=""
value="" maxlength="60"><label class="form-sub-label" for="input_44_state" id="sublabel_44_state" style="min-height:13px">State / Province</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" id="input_44_postal" name="q44_addressApplying[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="section-input_44 off" data-component="zip"
aria-labelledby="label_44 sublabel_44_postal" value="" maxlength="20"><label class="form-sub-label" for="input_44_postal" id="sublabel_44_postal" style="min-height:13px">Postal / Zip Code</label></span></span></div>
</div>
</div>
</li>
<li class="form-line" data-type="control_divider" id="id_46" data-css-selector="id_46">
<div id="cid_46" class="form-input-wide">
<div class="divider" data-component="divider" style="border-bottom-width:1px;border-bottom-style:solid;border-color:#e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px"></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_fullname" id="id_4" data-css-selector="id_4"><label class="form-label form-label-top form-label-auto" id="label_4" for="first_4" aria-hidden="false"> Your Name<span
class="form-required">*</span> </label>
<div id="cid_4" class="form-input-wide jf-required">
<div data-wrapper-react="true" class="extended"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="first"><input type="text" id="first_4" name="q4_yourName[first]" class="form-textbox validate[required]"
data-defaultvalue="" autocomplete="section-input_4 given-name" size="10" data-component="first" aria-labelledby="label_4 sublabel_4_first" required="" value=""><label class="form-sub-label" for="first_4" id="sublabel_4_first"
style="min-height:13px">First Name</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="middle"><input type="text" id="middle_4" name="q4_yourName[middle]" class="form-textbox"
data-defaultvalue="" autocomplete="section-input_4 additional-name" size="10" data-component="middle" aria-labelledby="label_4 sublabel_4_middle" required="" value=""><label class="form-sub-label" for="middle_4" id="sublabel_4_middle"
style="min-height:13px">Middle Name</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="last"><input type="text" id="last_4" name="q4_yourName[last]" class="form-textbox validate[required]"
data-defaultvalue="" autocomplete="section-input_4 family-name" size="15" data-component="last" aria-labelledby="label_4 sublabel_4_last" required="" value=""><label class="form-sub-label" for="last_4" id="sublabel_4_last"
style="min-height:13px">Last Name</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_phone" id="id_6" data-css-selector="id_6"><label class="form-label form-label-top form-label-auto" id="label_6" for="input_6_area" aria-hidden="false"> Phone number of Applicant<span
class="form-required">*</span> </label>
<div id="cid_6" class="form-input-wide jf-required">
<div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top" data-input-type="areaCode"><input type="tel" id="input_6_area" name="q6_phoneNumber[area]" class="form-textbox validate[required]"
data-defaultvalue="" autocomplete="section-input_6 tel-area-code" data-component="areaCode" aria-labelledby="label_6 sublabel_6_area" required="" value=""><span class="phone-separate" aria-hidden="true"> -</span><label
class="form-sub-label" for="input_6_area" id="sublabel_6_area" style="min-height:13px">Area Code</label></span><span class="form-sub-label-container" style="vertical-align:top" data-input-type="phone"><input type="tel"
id="input_6_phone" name="q6_phoneNumber[phone]" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="section-input_6 tel-local" data-component="phone" aria-labelledby="label_6 sublabel_6_phone" required=""
value=""><label class="form-sub-label" for="input_6_phone" id="sublabel_6_phone" style="min-height:13px">Phone Number</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_birthdate" id="id_10" data-css-selector="id_10"><label class="form-label form-label-top form-label-auto" id="label_10" for="input_10" aria-hidden="false"> Date of Birth of Applicant<span
class="form-required">*</span> </label>
<div id="cid_10" class="form-input-wide jf-required">
<div data-wrapper-react="true"><span class="form-sub-label-container" style="vertical-align:top"><select name="q10_dateOf[month]" id="input_10_month" class="form-dropdown validate[required]" data-component="birthdate-month"
aria-labelledby="label_10 sublabel_10_month">
<option value="">Please select a month</option>
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select><label class="form-sub-label" for="input_10_month" id="sublabel_10_month" style="min-height:13px">Month</label></span><span class="form-sub-label-container" style="vertical-align:top"><select name="q10_dateOf[day]"
id="input_10_day" class="form-dropdown validate[required]" data-component="birthdate-day" aria-labelledby="label_10 sublabel_10_day">
<option value="">Please select a day</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select><label class="form-sub-label" for="input_10_day" id="sublabel_10_day" style="min-height:13px">Day</label></span><span class="form-sub-label-container" style="vertical-align:top"><select name="q10_dateOf[year]"
id="input_10_year" class="form-dropdown validate[required]" data-component="birthdate-year" aria-labelledby="label_10 sublabel_10_year">
<option value="">Please select a year</option>
<option value="2024">2024</option>
<option value="2023">2023</option>
<option value="2022">2022</option>
<option value="2021">2021</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
</select><label class="form-sub-label" for="input_10_year" id="sublabel_10_year" style="min-height:13px">Year</label></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_number" id="id_70" data-css-selector="id_70"><label class="form-label form-label-top form-label-auto" id="label_70" for="input_70" aria-hidden="false"> Social Security Number<span
class="form-required">*</span> </label>
<div id="cid_70" class="form-input-wide jf-required"> <input type="number" id="input_70" name="q70_socialSecurity70" data-type="input-number" class=" form-number-input form-textbox validate[required]" data-defaultvalue="" style="width:180px"
size="20" placeholder="###-##-####" data-component="number" aria-labelledby="label_70" required="" step="any" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_number" id="id_71" data-css-selector="id_71"><label class="form-label form-label-top form-label-auto" id="label_71" for="input_71" aria-hidden="false"> Driver's License Number<span
class="form-required">*</span> </label>
<div id="cid_71" class="form-input-wide jf-required"> <input type="number" id="input_71" name="q71_driversLicense" data-type="input-number" class=" form-number-input form-textbox validate[required]" data-defaultvalue="" style="width:180px"
size="20" placeholder="###-##-####" data-component="number" aria-labelledby="label_71" required="" step="any" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_address" id="id_39" data-css-selector="id_39"><label class="form-label form-label-top form-label-auto" id="label_39" for="input_39_state" aria-hidden="false"> Driver's License State<span
class="form-required">*</span> </label>
<div id="cid_39" class="form-input-wide jf-required">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" id="input_39_addr_line1" name="q39_driversLicense39[addr_line1]" class="form-textbox validate[required] form-address-line" data-defaultvalue="" autocomplete="section-input_39 off"
data-component="address_line_1" aria-labelledby="label_39 sublabel_39_addr_line1" required="" value="" maxlength="100"><label class="form-sub-label" for="input_39_addr_line1" id="sublabel_39_addr_line1"
style="min-height:13px">Street Address</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" id="input_39_addr_line2" name="q39_driversLicense39[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_39 off"
data-component="address_line_2" aria-labelledby="label_39 sublabel_39_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_39_addr_line2" id="sublabel_39_addr_line2" style="min-height:13px">Street Address
Line 2</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" id="input_39_city" name="q39_driversLicense39[city]" class="form-textbox validate[required] form-address-city" data-defaultvalue="" autocomplete="section-input_39 off"
data-component="city" aria-labelledby="label_39 sublabel_39_city" required="" value="" maxlength="60"><label class="form-sub-label" for="input_39_city" id="sublabel_39_city" style="min-height:13px">City</label></span></span><span
class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><select class="form-dropdown validate[required] form-address-state"
name="q39_driversLicense39[state]" id="input_39_state" data-component="state" required="" aria-labelledby="label_39 sublabel_39_state" autocomplete="section-input_39 address-level1">
<option value="" selected="">Please Select</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
</select><label class="form-sub-label" for="input_39_state" id="sublabel_39_state" style="min-height:13px">State</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" id="input_39_postal" name="q39_driversLicense39[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="section-input_39 off" data-component="zip"
aria-labelledby="label_39 sublabel_39_postal" value="" maxlength="20"><label class="form-sub-label" for="input_39_postal" id="sublabel_39_postal" style="min-height:13px">Zip Code</label></span></span></div>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_email" id="id_5" data-css-selector="id_5"><label class="form-label form-label-top form-label-auto" id="label_5" for="input_5" aria-hidden="false"> E-mail of Applicant<span
class="form-required">*</span> </label>
<div id="cid_5" class="form-input-wide jf-required"> <input type="email" id="input_5" name="q5_emailOf" class="form-textbox validate[required, Email]" data-defaultvalue="" autocomplete="section-input_5 email" size="30"
placeholder="ex: myname@example.com" data-component="email" aria-labelledby="label_5" required="" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_dropdown" id="id_47" data-css-selector="id_47"><label class="form-label form-label-top form-label-auto" id="label_47" for="input_47" aria-hidden="false"> Marital Status<span
class="form-required">*</span> </label>
<div id="cid_47" class="form-input-wide jf-required"> <select class="form-dropdown validate[required]" id="input_47" name="q47_maritalStatus" style="width:150px" data-component="dropdown" required="" aria-label="Marital Status">
<option value=""></option>
<option value="Single">Single</option>
<option value="Married">Married</option>
<option value="Divorced">Divorced</option>
</select> </div>
</li>
<li class="form-line" data-type="control_divider" id="id_65" data-css-selector="id_65">
<div id="cid_65" class="form-input-wide">
<div class="divider" data-component="divider" style="border-bottom-width:1px;border-bottom-style:solid;border-color:#e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px"></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_address" id="id_9" data-css-selector="id_9"><label class="form-label form-label-top form-label-auto" id="label_9" for="input_9undefined" aria-hidden="false"> Current Address of Applicant<span
class="form-required">*</span> </label>
<div id="cid_9" class="form-input-wide jf-required">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_9_addr_line1" name="q9_currentAddress[addr_line1]" class="form-textbox validate[required] form-address-line" data-defaultvalue="" autocomplete="section-input_9 off" data-component="address_line_1"
aria-labelledby="label_9 sublabel_9_addr_line1" required="" value="" maxlength="100"><label class="form-sub-label" for="input_9_addr_line1" id="sublabel_9_addr_line1" style="min-height:13px">Street Address</label></span></span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_9_addr_line2" name="q9_currentAddress[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_9 off" data-component="address_line_2"
aria-labelledby="label_9 sublabel_9_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_9_addr_line2" id="sublabel_9_addr_line2" style="min-height:13px">Street Address Line 2</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_9_city" name="q9_currentAddress[city]" class="form-textbox validate[required] form-address-city" data-defaultvalue="" autocomplete="section-input_9 off" data-component="city" aria-labelledby="label_9 sublabel_9_city"
required="" value="" maxlength="60"><label class="form-sub-label" for="input_9_city" id="sublabel_9_city" style="min-height:13px">City</label></span></span><span
class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_9_state" name="q9_currentAddress[state]"
class="form-textbox validate[required] form-address-state" data-defaultvalue="" autocomplete="section-input_9 off" data-component="state" aria-labelledby="label_9 sublabel_9_state" required="" value="" maxlength="60"><label
class="form-sub-label" for="input_9_state" id="sublabel_9_state" style="min-height:13px">State / Province</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_9_postal" name="q9_currentAddress[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="section-input_9 off" data-component="zip" aria-labelledby="label_9 sublabel_9_postal" value=""
maxlength="20"><label class="form-sub-label" for="input_9_postal" id="sublabel_9_postal" style="min-height:13px">Postal / Zip Code</label></span></span><span
class="form-address-line form-address-country-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><select class="form-dropdown validate[required] form-address-country"
name="q9_currentAddress[country]" id="input_9_country" data-component="country" required="" aria-labelledby="label_9 sublabel_9_country" autocomplete="section-input_9 off">
<option value="">Please Select</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="The Bahamas">The Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia">Bolivia</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Cote d'Ivoire">Cote d'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Democratic Republic of the Congo">Democratic Republic of the Congo</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands">Falkland Islands</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Polynesia">French Polynesia</option>
<option value="Gabon">Gabon</option>
<option value="The Gambia">The Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran">Iran</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="North Korea">North Korea</option>
<option value="South Korea">South Korea</option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Laos">Laos</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macau">Macau</option>
<option value="Macedonia">Macedonia</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia">Micronesia</option>
<option value="Moldova">Moldova</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Nagorno-Karabakh">Nagorno-Karabakh</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="Netherlands Antilles">Netherlands Antilles</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Turkish Republic of Northern Cyprus">Turkish Republic of Northern Cyprus</option>
<option value="Northern Mariana">Northern Mariana</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine">Palestine</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn Islands">Pitcairn Islands</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Republic of the Congo">Republic of the Congo</option>
<option value="Romania">Romania</option>
<option value="Russia">Russia</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthelemy">Saint Barthelemy</option>
<option value="Saint Helena">Saint Helena</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin">Saint Martin</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="Somaliland">Somaliland</option>
<option value="South Africa">South Africa</option>
<option value="South Ossetia">South Ossetia</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard">Svalbard</option>
<option value="eSwatini">eSwatini</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syria">Syria</option>
<option value="Taiwan">Taiwan</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania">Tanzania</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Transnistria Pridnestrovie">Transnistria Pridnestrovie</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tristan da Cunha">Tristan da Cunha</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Isle of Man">Isle of Man</option>
<option value="US Virgin Islands">US Virgin Islands</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
<option value="other">Other</option>
</select><label class="form-sub-label" for="input_9_country" id="sublabel_9_country" style="min-height:13px">Country</label></span></span></div>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_widget" id="id_43" data-css-selector="id_43"><label class="form-label form-label-top form-label-auto" id="label_43" for="input_43" aria-hidden="false"> Current Address Info<span
class="form-required">*</span> </label>
<div id="cid_43" class="form-input-wide jf-required">
<div data-widget-name="Multiple Text Fields" style="width:100%;text-align:Left;overflow-x:auto" data-component="widget-field"><iframe data-client-id="538dddaa976bf61129000004" title="Multiple Text Fields" frameborder="0" scrolling="no"
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<div class="widget-inputs-wrapper"><input id="input_43" class="form-hidden form-widget widget-required " type="hidden" name="q43_currentAddress43" value=""><input id="widget_settings_43" class="form-hidden form-widget-settings"
type="hidden" data-version="2" value="%5B%7B%22name%22%3A%22fields%22%2C%22value%22%3A%22How%20long%20there%3F%5CnIs%20your%20rent%20current%3F%5CnReason%20for%20leaving%3F%5CnLandlord's%20Name%5CnLandlord's%20Phone%20%23%22%7D%5D">
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</div>
</li>
<li class="form-line" data-type="control_divider" id="id_64" data-css-selector="id_64">
<div id="cid_64" class="form-input-wide">
<div class="divider" data-component="divider" style="border-bottom-width:1px;border-bottom-style:solid;border-color:#e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px"></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_address" id="id_66" data-css-selector="id_66"><label class="form-label form-label-top form-label-auto" id="label_66" for="input_66_addr_line1" aria-hidden="false"> Previous Address of
Applicant<span class="form-required">*</span> </label>
<div id="cid_66" class="form-input-wide jf-required">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_66_addr_line1" name="q66_previousAddress[addr_line1]" class="form-textbox validate[required] form-address-line" data-defaultvalue="" autocomplete="section-input_66 address-line1" data-component="address_line_1"
aria-labelledby="label_66 sublabel_66_addr_line1" required="" value="" maxlength="100"><label class="form-sub-label" for="input_66_addr_line1" id="sublabel_66_addr_line1" style="min-height:13px">Street
Address</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_66_addr_line2" name="q66_previousAddress[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="section-input_66 address-line2" data-component="address_line_2"
aria-labelledby="label_66 sublabel_66_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_66_addr_line2" id="sublabel_66_addr_line2" style="min-height:13px">Street Address Line 2</label></span></span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_66_city" name="q66_previousAddress[city]" class="form-textbox validate[required] form-address-city" data-defaultvalue="" autocomplete="section-input_66 address-level2" data-component="city"
aria-labelledby="label_66 sublabel_66_city" required="" value="" maxlength="60"><label class="form-sub-label" for="input_66_city" id="sublabel_66_city" style="min-height:13px">City</label></span></span><span
class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_66_state" name="q66_previousAddress[state]"
class="form-textbox validate[required] form-address-state" data-defaultvalue="" autocomplete="section-input_66 address-level1" data-component="state" aria-labelledby="label_66 sublabel_66_state" required="" value=""
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<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
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<li class="form-line" data-type="control_divider" id="id_40" data-css-selector="id_40">
<div id="cid_40" class="form-input-wide">
<div class="divider" data-component="divider" style="border-bottom-width:1px;border-bottom-style:solid;border-color:#e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px"></div>
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<li class="form-line" data-type="control_divider" id="id_48" data-css-selector="id_48">
<div id="cid_48" class="form-input-wide">
<div class="divider" data-component="divider" style="border-bottom-width:1px;border-bottom-style:solid;border-color:#e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px"></div>
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<li class="form-line jf-required" data-type="control_widget" id="id_42" data-css-selector="id_42"><label class="form-label form-label-top form-label-auto" id="label_42" for="input_42" aria-hidden="false"> PROPOSED OCCUPANTS - List ALL occupants
other than yourself. NOTE: You must fill out an applications for all occupants over 18 (including your spouse). Name, Relationship, Age.<span class="form-required">*</span> </label>
<div id="cid_42" class="form-input-wide jf-required">
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<li class="form-line jf-required" data-type="control_widget" id="id_51" data-css-selector="id_51"><label class="form-label form-label-top form-label-auto" id="label_51" for="input_51" aria-hidden="false"> PROPOSED PETS - List ALL pets - Size,
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<div id="cid_51" class="form-input-wide jf-required">
<div data-widget-name="Dynamic Textbox" style="width:100%;text-align:Left;overflow-x:auto" data-component="widget-field"><iframe data-client-id="528ee7cf8d5a5fc76a000004" title="Dynamic Textbox" frameborder="0" scrolling="no"
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<li class="form-line" data-type="control_divider" id="id_62" data-css-selector="id_62">
<div id="cid_62" class="form-input-wide">
<div class="divider" data-component="divider" style="border-bottom-width:1px;border-bottom-style:solid;border-color:#e6e6e6;height:1px;margin-left:0px;margin-right:0px;margin-top:5px;margin-bottom:5px"></div>
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</li>
<li class="form-line jf-required" data-type="control_radio" id="id_52" data-css-selector="id_52"><label class="form-label form-label-top form-label-auto" id="label_52" for="input_52_0" aria-hidden="false"> Has applicant ever been sued for
bills?<span class="form-required">*</span> </label>
<div id="cid_52" class="form-input-wide jf-required">
<div class="form-single-column" role="group" aria-labelledby="label_52" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_52" type="radio"
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</li>
<li class="form-line jf-required" data-type="control_radio" id="id_53" data-css-selector="id_53"><label class="form-label form-label-top form-label-auto" id="label_53" for="input_53_0" aria-hidden="false"> Has applicant ever been bankrupt?<span
class="form-required">*</span> </label>
<div id="cid_53" class="form-input-wide jf-required">
<div class="form-single-column" role="group" aria-labelledby="label_53" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_53" type="radio"
class="form-radio validate[required]" id="input_53_0" name="q53_hasApplicant53" required="" value="No"><label id="label_input_53_0" for="input_53_0">No</label></span><span class="form-radio-item" style="clear:left"><input type="radio"
class="form-radio-other form-radio validate[required]" name="q53_hasApplicant53" id="other_53" tabindex="0" aria-label="Yes - Explain" value="other"><label id="label_other_53" style="text-indent:0" for="other_53"><span
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placeholder="Yes - Explain"><br></span></div>
</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_54" data-css-selector="id_54"><label class="form-label form-label-top form-label-auto" id="label_54" for="input_54_0" aria-hidden="false"> Has applicant ever been guilty of a
felony?<span class="form-required">*</span> </label>
<div id="cid_54" class="form-input-wide jf-required">
<div class="form-single-column" role="group" aria-labelledby="label_54" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_54" type="radio"
class="form-radio validate[required]" id="input_54_0" name="q54_hasApplicant54" required="" value="No"><label id="label_input_54_0" for="input_54_0">No</label></span><span class="form-radio-item" style="clear:left"><input type="radio"
class="form-radio-other form-radio validate[required]" name="q54_hasApplicant54" id="other_54" tabindex="0" aria-label="Yes - Explain" value="other"><label id="label_other_54" style="text-indent:0" for="other_54"><span
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</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_55" data-css-selector="id_55"><label class="form-label form-label-top form-label-auto" id="label_55" for="input_55_0" aria-hidden="false"> Has applicant ever broken a
lease?<span class="form-required">*</span> </label>
<div id="cid_55" class="form-input-wide jf-required">
<div class="form-single-column" role="group" aria-labelledby="label_55" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_55" type="radio"
class="form-radio validate[required]" id="input_55_0" name="q55_hasApplicant55" required="" value="No"><label id="label_input_55_0" for="input_55_0">No</label></span><span class="form-radio-item" style="clear:left"><input type="radio"
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</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_56" data-css-selector="id_56"><label class="form-label form-label-top form-label-auto" id="label_56" for="input_56_0" aria-hidden="false"> Has applicant ever broken a
lease?<span class="form-required">*</span> </label>
<div id="cid_56" class="form-input-wide jf-required">
<div class="form-single-column" role="group" aria-labelledby="label_56" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_56" type="radio"
class="form-radio validate[required]" id="input_56_0" name="q56_hasApplicant56" required="" value="No"><label id="label_input_56_0" for="input_56_0">No</label></span><span class="form-radio-item" style="clear:left"><input type="radio"
class="form-radio-other form-radio validate[required]" name="q56_hasApplicant56" id="other_56" tabindex="0" aria-label="Yes - Explain" value="other"><label id="label_other_56" style="text-indent:0" for="other_56"><span
class="jfHiddenTextLabel">Other</span> </label><input type="text" class="form-radio-other-input form-textbox" name="q56_hasApplicant56[other]" data-otherhint="Yes - Explain" size="15" id="input_56"
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</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_57" data-css-selector="id_57"><label class="form-label form-label-top form-label-auto" id="label_57" for="input_57_0" aria-hidden="false"> Has applicant ever been locked out of
their apartment by the sheriff?<span class="form-required">*</span> </label>
<div id="cid_57" class="form-input-wide jf-required">
<div class="form-single-column" role="group" aria-labelledby="label_57" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_57" type="radio"
class="form-radio validate[required]" id="input_57_0" name="q57_hasApplicant57" required="" value="No"><label id="label_input_57_0" for="input_57_0">No</label></span><span class="form-radio-item" style="clear:left"><input type="radio"
class="form-radio-other form-radio validate[required]" name="q57_hasApplicant57" id="other_57" tabindex="0" aria-label="Yes - Explain" value="other"><label id="label_other_57" style="text-indent:0" for="other_57"><span
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</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_58" data-css-selector="id_58"><label class="form-label form-label-top form-label-auto" id="label_58" for="input_58_0" aria-hidden="false"> Has applicant ever been brought to
court by another landlord?<span class="form-required">*</span> </label>
<div id="cid_58" class="form-input-wide jf-required">
<div class="form-single-column" role="group" aria-labelledby="label_58" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_58" type="radio"
class="form-radio validate[required]" id="input_58_0" name="q58_hasApplicant58" required="" value="No"><label id="label_input_58_0" for="input_58_0">No</label></span><span class="form-radio-item" style="clear:left"><input type="radio"
class="form-radio-other form-radio validate[required]" name="q58_hasApplicant58" id="other_58" tabindex="0" aria-label="Yes - Explain" value="other"><label id="label_other_58" style="text-indent:0" for="other_58"><span
class="jfHiddenTextLabel">Other</span> </label><input type="text" class="form-radio-other-input form-textbox" name="q58_hasApplicant58[other]" data-otherhint="Yes - Explain" size="15" id="input_58"
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</div>
</li>
<li class="form-line jf-required" data-type="control_radio" id="id_59" data-css-selector="id_59"><label class="form-label form-label-top form-label-auto" id="label_59" for="input_59_0" aria-hidden="false"> Has applicant ever moved
owing rent or damaged an apartment?<span class="form-required">*</span> </label>
<div id="cid_59" class="form-input-wide jf-required">
<div class="form-single-column" role="group" aria-labelledby="label_59" data-component="radio"><span class="form-radio-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_59" type="radio"
class="form-radio validate[required]" id="input_59_0" name="q59_hasApplicant59" required="" value="No"><label id="label_input_59_0" for="input_59_0">No</label></span><span class="form-radio-item" style="clear:left"><input type="radio"
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</form>Text Content
* RENTAL APPLICATION Every occupant over the age of 18 MUST fill out a separate application (even if married). Please fill out this form COMPLETELY and electronically sign where indicated. * CITY REQUESTED:* Towanda El Dorado Augusta * ADDRESS APPLYING FOR:* Street Address Street Address Line 2 CityState / Province Postal / Zip Code * * Your Name* First NameMiddle NameLast Name * Phone number of Applicant* -Area CodePhone Number * Date of Birth of Applicant* Please select a month January February March April May June July August September October November December Month Please select a day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Day Please select a year 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Year * Social Security Number* * Driver's License Number* * Driver's License State* Street Address Street Address Line 2 City Please Select 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 State Zip Code * E-mail of Applicant* * Marital Status* Single Married Divorced * * Current Address of Applicant* Street Address Street Address Line 2 CityState / Province Postal / Zip Code Please Select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard eSwatini Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country * Current Address Info* * * Previous Address of Applicant* Street Address Street Address Line 2 CityState / Province Postal / Zip Code * Previous Address Info* * * Current Financial Info* * * PROPOSED OCCUPANTS - List ALL occupants other than yourself. NOTE: You must fill out an applications for all occupants over 18 (including your spouse). Name, Relationship, Age.* * PROPOSED PETS - List ALL pets - Size, Breed, Weight:* * * Has applicant ever been sued for bills?* NoOther * Has applicant ever been bankrupt?* NoOther * Has applicant ever been guilty of a felony?* NoOther * Has applicant ever broken a lease?* NoOther * Has applicant ever broken a lease?* NoOther * Has applicant ever been locked out of their apartment by the sheriff?* NoOther * Has applicant ever been brought to court by another landlord?* NoOther * Has applicant ever moved owing rent or damaged an apartment?* NoOther * Is the total move-in amount available now (rent and deposit)?* NoOther * * Check the box below to agree that applicant has legally signed this electronic document by typing their signature/name in the box above. Applicant authorizes the landlord to contact past and present landlords, employers, creditors, credit bureaus, neighbors and any other sources deemed necessary to investigate applicant. All information is true, accurate and complete to the best of applicant’s knowledge. Landlord reserves the right to disqualify tenant if information is not as represented. ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM OR A PHOTOCOPY OF THIS FORM AT ANY TIME.* I Agree * SIGNATURE - This electronic signature is binding and is to be used as my actual signature for this application.* Clear * Enter the message as it's shown* * Submit my application * Should be Empty: