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Are you currently working with another real estate agent
Type of rental needed
Preferred location (choose as many as desired)
Agana Heights
Agat
Asan – Maina
Barrigada
Ordot – Chalan Pago
Dededo
Hagatna
Inarajan
Mangilao
Merizo
Mongmong – Toto – Maite
Santa Rita
Sinajana
Talofofo
Tamuning
Umatac
Yigo
Yona
Total Number of Tenants including yourself
Proposed move-in date
List all other tenants' FULL name and their relationship to you
Any pets or service animal
Total Number of Vehicles in household
Contact person in case of emergency
Emergency Contact Person's phone number
Do you or the other proposed tenants plan to use liquid filled furniture
Yes
No
Have you been evicted or filed bankruptcy within the last seven years?
Yes
No
Have you ever been convicted to or pleaded no contest to a felony?
Yes
No
Have you ever been asked to move out of a residence?
Yes
No
If any of the last 3 questions were answered yes, explain below why
Current Home Address
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