LINCOLNSHIRE PROPERTIES
AND INVESTMENTS

DR. CHARLES C. LOZAR
P.O. Box 11451
Champaign, IL 61826

GINGER M. LOZAR
(217) 398-1998
FAX (217) 398-1998

LINCOLNSHIRE MANAGEMENT - TENANT APPLICATION FORM

Please fill in all information as completely as possible.
GENERAL INFORMATION
Full Name: e-mail:
Home Phone: Work Phone:
Social Security: Birth Date:
Driver's License: Driver's License State:
Marital Status: Spouse's Name:
Bicycle:      Yes      No U of I registration #:

RESIDENCE HISTORY
PRESENTPREVIOUS
Street Address: Street Address:
Landlord's Name: Landlord's name:
Landlord's Phone: Landlord's Phone:
Monthly Rent Per Unit: Monthly Rent Per Unit:
Monthly Rent Per Occupant: Monthly Rent Per Occupant:
Number of Occupants: Number of Occupants:
Lease Term From:             To: Lease Term From:             To:

EMPLOYMENT INFORMATION
Employer's Name:
Employer's Address:
City/State/Zip:
Employer's Phone:
Employment Term:
Position Held:
Supervisor:
Yearly Income (Applicant): Yearly Income (Spouse):

SCHOOL INFORMATION
Year in School:   Freshman   Sophomore   Junior   Senior   Graduate
If Grad Student, Year:   1   2   3   4
Current School:   U of I   Parkland   Other:
Term Entered:   Jan.   June   Aug. Year:
Anticipated Graduation:   Jan.   June   Aug. Year:
Curriculum: Degree:

VEHICLE INFORMATION
Vehicle 1Vehicle 2
Type/Color: Type/Color:
Make/Model/Year: Make/Model/Year:
License#/State: License#/State:

EMERGENCY CONTACT
Name:
Address:
City/State/Zip:
Phone #: Relationship

Permanent Address
Name:
Address:
City/State/Zip:
Phone #: Relationship

SIGNATURE
I hereby make application for a rental lease agreement and certify that this information is correct. I authorize Lincolnshire Properties to contact any reference that I have listed.
Signed:
Date:

OFFICE USE ONLY
Landlord's Reference:
Employer's Reference:
Credit Bureau Check:
Application Approved:     Yes     No By:         Date: