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Rental Application Form

Date of Birth
Month
Day
Year

If you have no additional members, leave the box blank.

If additional members are over 18 years old, please provide their social security number.

Do you smoke?
Do you have any pets?
Have you been evicted before?

If no, leave blank or list NA.

Explain the charges and dates of the charges

Year, make, model, color, etc.

Preferred Payment Schedule
Will you be able to pay the security deposit and first month's rent upon lease signing?
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​6 To 10 Homes, LLC

Phone: 765-210-7701 
Email: 6to10homes@gmail.com

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