Welcome.

We look forward to you becoming a part of The Oaks at DeLand community.

Resident Application

Sales Agent Name

First Name

Last Name

Sales Agent Phone

(###)

###

####

Anticipated Closing Date

YYYY

Intended Property

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Applicant Personal Information

Applicant Name

First Name

Last Name

Applicant Email

Applicant Social Security Number

Applicant DOB

YYYY

Drivers License + State

Spouse Personal Information

Spouse Name

First Name

Last Name

Spouse Social Security Number

Spouse DOB

YYYY

Spouse Drivers License + State

Other Name

First Name

Last Name

Other Relationship

Other Age

Other Social Security Number

Pet Type

Pet Breed

Pet Weight

Pet Color

Pet Age

Home Information

Home Phone

(###)

###

####

Why Moving?

Present Landlord / Mortgage Holder

Landlord Phone

(###)

###

####

Length of Residence

Monthly Rent / Mortgage

Mortgage Account Number

Current / Previous Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Personal Reference 1

Reference 1 Name

First Name

Last Name

Reference 1 Phone

(###)

###

####

Personal Reference 2

Reference 2 Name

First Name

Last Name

Reference 2 Phone

(###)

###

####

Applicant Employment

Applicant Present Employer

Employer City + State

Employer Phone

(###)

###

####

Monthly Income

Monthly Social Security

Monthly Pension

Spouse Employment

Spouse / Partner Present Employer

Spouse Employer City + State

Spouse Employer Phone

(###)

###

####

Spouse Monthly Income

Spouse Monthly Social Security

Spouse Monthly Pension

Combined Income for Household Application

Total Income

Emergency Contact

Emergency Contact Name

First Name

Last Name

Emergency Contact Relationship

Emergency Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone

(###)

###

####

How did you learn about us?

Legal Background Information

Has any applicant listed on this form, or any person or persons that will be residing at the address indicated on this application ever been convicted of a crime, pled no contest, or had an adjudication withheld?

YES

If the answer is ‘yes’, please provide details including dates, location(s), charges and a complete explanation of all offenses.

Note that any such information may not necessarily result in disapproval of this application. Amicorp, Inc. including all subsidiaries and affiliates, at their sole discretion may consider the nature, date and circumstances of any and all offenses listed herein in order to determine the disposition of this application.

AUTHORIZATION TO RELEASE INFORMATION

Applicant(s) hereby authorizes Amicorp, Inc. including any and all subsidiaries, associates and assigns to apply for and make inquiry for an investigative consumer report including, but not limited to residential history (rental or mortgage), employment history, criminal history records, court records, and credit records. This application must be signed before it can be processed by management. In such case of a sub-lease agreement, results of said investigative report as described herein shall also be made available to the sub-lessor for the individual property listed in this application listed as “intended property” within this form. By signing this document, applicant(s) affirm that the information herein is true, accurate and complete to the best of their knowledge with the understanding that submission of false, omitted, or misleading information herein can be used as grounds for denial of this application, eviction from the property, or termination of any rental agreement with an Amicorp community. Applicant(s) hereby assert that they have reviewed and do agree to abide by the Rules & Regulations currently applied to all residents of the Oaks. Applicant(s) acknowledge that false or omitted information herein may constitute a criminal offense under laws of this state. NON-REFUNDABLE APPLICATION FEE: Applicant(s) agree to pay $100.00 as a non-refundable processing fee made payable to “The Oaks”.

Applicant Signature Date

YYYY

Spouse Signature

Spouse Signature Date

YYYY

Please email all requested documents to theoaks@amicorpinc.com