Equal Housing Opportunity
Complete Application Below
and click Submit
Coulee Development, Inc
N15526 Delaney Rd. Trempealeau, WI. 54661
make this application to rent the following property(s):
(Check appropriate items):
Ridgeview Estates Apartments - Hwy
Galesville, WI. (Select which units you are interested
8-plex 932 sq, ft. 2 bdrm 1 bath w/detached
garage @ $750 per mo. (Blue Buildings)
(Plus Electric & Water)
12-plex 1030-1150 sq. ft. 2 bdrm 2 bath w/tuck
under garage @ $900-$950 per mo. (Brown
(Plus Electric, Water Included in Rent)
Pets $100 Additional Non-refundable Deposit.
Plus $10 additional per pet
Anticipated move date
PLEASE TELL US ABOUT YOURSELF
Full Name Home/Cell Phone .
Date of Birth
must be at least 18 years of age) Social Security # .
Co-Applicant Date of Birth
Co-Applicant SSN #
Dependents Names & Dates of Birth
List Type & Name of All Pets (See Pet Addendum, add. Costs
PLEASE GIVE RESIDENTIAL HISTORY (LAST 3 YEARS)
Month/Year Moved In
Reasons for Leaving
Previous Address (If less than 3 years at current address)
PLEASE DESCRIBE YOUR CREDIT HISTORY (These questions apply to all
PLEASE PROVIDE YOUR EMPLOYMENT INFORMATION
Your Employment Status:
Employer/School You Attend:
Dates employed/In School
Supervisor Name/School Administrator
If employed by above less than 12 months, give name & phone of
previous employer or school:
If you have other sources of income that you would like us to
consider, please list income, source, and person (banker,
employer, etc.) who we may contact for confirmation. You do
not have to reveal alimony, child support, or spouse's
annual income unless you want us to consider it in this
Amount $ Source/Contact Name
Credit: A complete
check of credit history will be made. Applicant must
have a favorable credit rating. No charged off accounts,
collections, judgements, or bankruptcies
within the past five years will be accepted.
Income: A prospective resident must meet the minimum
1 Occupants: Must have gross monthly income of at least 3
times monthly rent.
2 Occupants: Must have combined gross monthly income of
at least 3.5 times the monthly rent.
3 Occupants: Must have combined gross monthly income of
at least 4 times the monthly rent.
PLEASE LIST YOUR REFERENCES
Personal Reference or Emergency Contact:
Your Driver's License Number
Vehicle (s) Information:
Make / Model
License Plate State
Make / Model
License Plate State
** The Applicant must have a
positive past rental reference or have previously owned a
home (with mortgage in good standing). This includes no late
rent payments, Unlawful Detainers, or lease violations.
Please give any additional information that might help
owner/management evaluate this application?
Where may we reach you to discuss this application?
Day Phone #
Night Phone #
- Submission of this
application does not serve as a reservation of
the apartment you are applying for.
- All information provided on the application
must be complete and correct or we will be
unable to process your application.
- Inability to verify any portion or finding
discrepancies is basis for rejection.
- If the application is accepted, you will be
notified by telephone to set up a lease signing.
- If the application is denied, you will receive
a denial letter..
I hereby apply to lease the above described premises for the
term and upon the set conditions above set forth and agree
that the rental is to be payable the first day of each month
in advance. As an inducement to the owner of the property
and to the agent to accept this application, I warrant that
all statements above set forth are true.
I recognize that as a part of your procedure for processing
my application, an investigative consumer report may be
prepared whereby information is obtained through personal
interviews with others with whom I may be acquainted. This
inquiry includes information as to my character, general
reputation, personal characteristics and mode of living.
The above information, to the best of my knowledge, is true
Please sign: X
Release of Information
I authorize the release of
income and employment history from my current and previous
employers as well as rental history from my current and
previous landlords. This release is valid for 1 year, unless
limited by state law, in which case the authorization
continues in effect for the maximum period, not to exceed
one year, or as allowed by law.
Name (please print)
Be sure to Print
this page for your records.
PLEASE DO NOT WRITE BELOW (FOR OFFICE USE ONLY)
Received by ____________________________ Date_______________
Development Inc.,N15526 Delaney Rd,
Trempealeau, WI 54661
Toll Free 877-2BUY-CDI,
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