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Phone: (574) 267-8816

Woodward Realty and Insurance.

print out and fill out this page and fax to 574/267-2067




NAME Birthdate SSN
Cotenant Birthdate SSN
Number of Children (or other occupants) Number & Kind of Pets

Phone How long Monthly Rent
Why are you moving?

Landlord Address Phone #

Previous Address How Long? Date Left
Landlord Address Phone #

EMPLOYER How long? Monthly Gross Income
Superior Work Phone
Cotenant How Long? Monthly Gross Income
Superior Work Phone
If less than one year with current employer, complete the following:

Previous Employer How Long? Date Left
Superior's Name & Phone # Reason Left?
Car Make Model Year
Color Mthly Pymnt


Bank How Long? Checking Acc't? Y / N Savings Acc't Y / N
Credit Acc'ts?

Personal References (Have known you for at least three years, not family)

1. Address Phone #

2. Address Phone #

In case of emergency, notify Name Phone #


Have you ever filed bankruptcy? Yes / No Date
Have you ever been evicted from a tenancy? Yes / No Where/When

I declare that the foregoing to be true under the penalty of perjury. and I agree that may terminate any agreement entered into in reliance on any misstatements made above.

(I)(We) give Woodward Realty & Insurance, Inc. (WR&I) authorization to check (my) (our) credit history. (I)(We) also understand that any information obtained through such credit check will be held in the strictest confidence by the personnel of WR&I. Rejection of application may result as defined on reverse side of this application.

DISCLOSURE: Woodward Realty & Insurance, Inc. (WR&I) is an agent for the owners of the properties (LESSORS) for which this application is being filed for, and owe duties of trust, loyalty, confidentiality, fiduciality, and disclosure to the owners. WR&I is compensated by the Lessors through a percentage or flat sum of the rents paid by Lessees. By signing below you acknowledge this disclosure.


Applicant's Signature Date

Applicant's Signature Date



Woodword Property Management has the right to accept or reject applications at their discretion using the following guidelines:

1. Application is not filled out completely.
2. Unsatisfactory credit report consisting of two (2) or more unpaid collections; paid or unpaid collectlons/judgements from former landlords; unpaid collections from utility companies; one (1) or more judgements; more than two (2) revolving or installment payment with a rating of three (3) or above.
No credit history or very minimal credit history.
3. Unsatisfactory rental references. Previous eviction automatic reason for denial .
4. No rental references. (References from family members are unacceptable.)
5. Applicant is not employed. If employed, must have at least four (4) weeks on present job and at least six (6) months on previous job. If self employed, applicant must submit previous year's tax return.
6. Income doesn't meet minimum financial requirement: Rent cannot exceed 25% of Gross Income.
7. Information on application is falsified.
8. Using a an incorrect or falsified social security number.
9. Applicant has pet and premises does not allow pet.
10. Applicant smokes and premises is a nonsmoking premises.
11. Number of people exceeds maximum occupancy limit per local housing codes.
12. Any statements made by applicant which could be considered to be deceiving in order to gain residency.


1128 East Winona Avenue
Warsaw, Indiana 46580
(574) 267-8816