Applicant Information
Applicant name (first, middle, last)
Date of birth (mm/dd/yyyy)
Email Phone
Current Employer
Job title
Start date
Wage/Salary
Supervisor name Supervisor phone
Current address
How long have you lived at this address?
Current rent  or mortgage payment
Landlord name Landlord phone
Have you ever been late on your rent/house payment?	Yes No
Have you ever been evicted?	Yes No
Please list any felony convictions
Co-Applicant Information
Co-Applicant name (first, middle, last)
Date of birth (mm/dd/yyyy)
Email Phone
Current Employer
Job title
Start date
Wage/Salary
Supervisor name Supervisor phone
Current address
How long have you lived at this address?
Current rent  or mortgage payment
Landlord name Landlord phone
Have you ever been late on your rent/house payment?	Yes No
Have you ever been evicted?	Yes No
Please list any felony convictions
Which property are you interested in?
If seeking land contract, how much do you have for a downpayment?
I agree that all information provided is accurate. I give Queck Capital Management/Queck Properties my consent to verify all provided information. Yes No