COX RENTALS, LLC

PO BOX 313
Horseheads, NY
14845
(607) 739.0355.     (607) 738.9228
cindyiva@aol.com

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ABOUT YOURSELF

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CO-APPLICANT

Name
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RESIDENCY HISTORY FOR THE PAST 3 YEARS

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Land Lord's NameThis is a required field

Prior Address (if within 3 years)

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Land Lord's NameThis is a required field

Prior Address (if within 3 years)

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Employment Information

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Current Employer Information

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Previous Employer Information

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Prior Rental Legal Issues

Have You Or Your Co-Applicant Ever:

Been Sued For Non-Payment of Rent
Been Evicted Or Asked To Move Out
Broken A Rental Agreement Or Lease
Been Sued For Damage To Rental Property
Declared Bankruptcy
In case we have any questions regarding your application, please provide a phone number where you can be reached:

Emergency Contact Information

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Please Provide The Following With Your Application

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Clear Signature
Clear Signature