Desert Rose Apartments

29 N 28th St OFFICE Las Vegas, NV 89101     702-384-3101
Applicant Information:
Your Name   Birth Date   SS/SI #
Email     Phone Number   Gender
License # Exp Date State/Province
Applicant Current Address & Move Status:
Address   City   State/Province  
Postal Code Landlord Name Landlord Phone
There Since Lease/Rent Amt Reason Moving  0/32
Move Date Min Beds Min Baths
Co-Applicant Information:
Name Birth Date SS/SI #
Email   Phone Number Gender
License # Exp Date State/Province
Additional Tenants Information:
Name Birth Date Relationship
Name Birth Date Relationship
Pet Information:
Pet Name Breed/Type Size/Weight
Pet Name Breed/Type Size/Weight
Veterinarian Phone Number
Vehicle Information:
Year Make/Model Color License # State/Province
Year Make/Model Color License # State/Province
Applicant Current Employment:
Employer Position Start Date
Supervisor Phone Number Monthly Net Pay
Address  0/64
Applicant Emergency Contact:
Name Phone Number Relationship
Physician Phone Number
History & Status:
Have you ever been evicted or had problems with any landlords? 0/128
Have you (or any co-occupants) ever been arrested for a crime? 0/128
Describe your current move status 0/256
I declare that this application is complete, true and correct. I hereby give permission to verify by reasonable means this application, including but not limited to credit check, criminal history, eviction records, landlord verification, and/or verification of employment. I understand that any false information will constitute grounds for rejection of this application, and may terminate any agreement entered into in reliance upon misinformation given in this application.
Applicant Signature (type full name)
Co-Applicant Signature (type full name)