Rental Request Form

Prospect Information First Name: Last Name: Address: Apartment #: City: State: Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming non-US Zip Code: Home Phone: Work Phone: Ext: Cell Phone: Email Address: Rental Requests Unit Type Desired : Please Select Studio 1BR 2BR 2BR with Den 3BR Property Desired: Lyndale Place Renaissance North Renaissance West Wicker Park Place Renaissance Saint Luke My price range is: per month My Annual Gross Household Income is: Please include all income source from each member of the household Number of Persons to Occupy Unit: 1 2 3 4 5 6 When would you like to move in? Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / 2004 2005 2006 2007 2008 2009 2010 What amenities are you looking for in your new home? Do you have any pets? Yes No If yes, please specify type of pet. What is important to you when selecting a community? How did you hear about The Renaissance Companies?