Please complete this application and email it to us at markabuzzotta@comcast.net
or fax it to 678-278-1209.
Thank you,
Mark A. Buzzotta
tel: 678-887-4599
APPLICATION
The applying resident must complete this application.
If the resident is a student, a parent/guarantor must also complete
the application.
NO PETS ALLOWED
Name of resident:________________________________________
SS#________________________________
Date of Birth____________________
email____________________________________________
All Telephone Numbers________________________________________________
Driver’s Lic #______________________________State________________________
Present Address______________________________
City_________________State___________
How long at this address__________
Landlord___________________Tel#___________________
Prior Address_______________________________________
City________________State_____________
How long ________________
Landlord_______________________Tel#_______________________
Employer___________________________________
Position_______________________________
Address____________________________
City________________State________ Zip_______
Tel#__________________________
Current Salary___________ How long_____________________
Parent/Guarantor:_____________________________________
SS#___________________________
Date of Birth____________________
email_____________________________________________
All Telephone Numbers _________________________________________________
Driver’s Lic #______________________________State________________________
Present Address_________________________
City_________________State___________
How long at this address__________
Landlord___________________Tel#___________________
Prior Address___________________________
City________________State_____________
How long ________________
Landlord_______________________Tel#_______________________
Employer___________________________________
Position_______________________________
Address_________________________________
City________________State________ Zip_______
Tel#__________________________
Current Salary_____________ How long____________
List all vehicles of the resident:
Make/Model___________________year____color_____Tag#_____________State__
Make/Model___________________year____color_____Tag#_____________State__
List Names of Bank(s)___________________________________________________
List Names of Bank(s) or institutions that have issued you a credit card
(not debit card): _________________________________________________________
____________________________________________________________
Have any applicants listed filed for bankruptcy?_________
Which Adult(s)_____________ When_________
Have any of the Adults listed been served an eviction notice
or asked to vacate?_____________________
Have any of the adults been convicted of a Felony? ______________
Which Adult(s)________________
What was the offense__________________________________________
The adults listed on this application declare under the penalty of perjury that the
information listed in this application is true and correct. All adults listed authorize
Mark A. Buzzotta to investigate their credit, residential, criminal and employment history.
All adults listed authorize release of this information and indemnify this landlord
of any liability related to the information and of the use of the information for
application selection.
____________________________________________ Date_______________________________
Resident’s Signature
____________________________________________ Date________________________________
Parent/Guarantor’s Signature
Name