Apartment Inquiry Form

In order to prescreen, please provide accurate information regarding your household. This information will be third party verified as part of the application process. Fields marked with (*) are required.

First Name: *

Phone Number: *

Last Name: *

Email: *

Which building are you interested in? *

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When were you hoping to move? *

What unit size are you interested in? *

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Total number of people in household? *

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How many 17 yrs and older? *

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All Full-time students? *

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Open bankruptcies? *

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Able to provide 12 months current Rental History, with no gaps? *

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Owe any past Landlords money? *

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If Yes, how much?

Any non-medical debt in collections? (i.e. student loans, credit cards, cable services?) *

Eviction in the past 3 years? *

Received any Legal Notices in the past 12 months? *

Length of current employment? *

How did you hear about us? *

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Please provide all applicable Income Information *

Gross Annual Income:

Hourly Wage:

$

Monthly Wage:

Tips/Bonus / month:

Pension or Soc. Sec. / month:

Child Support / month:

Other Income / month:

Voucher Amount and Type / month:

If Self-Employed: Net Annual Income (Includes side jobs, contractors)

If Self-Employed: Taxes filed per IRS guidelines?

$

X

Hours / week

$

$

$

$

$

$

$

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Notes:

Bellwether Housing

1651 Bellevue Avenue

Seattle WA, 98122

206-623-0506

bellwether@bellwetherhousing.org

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Copyright 2019 Bellwether Housing, All Rights Reserved

Bellwether Housing is a nonprofit 501(c)(3). Tax ID 91-1116960.