Pre-Application

General Information

* denotes required field
* Property:
* Name:
* Please enter e-mail address and/or phone number:
Email:
Phone:
Occupancy:
Adults: Children:
Child 1 Name:  Child 1 DOB: 
Child 2 Name:  Child 2 DOB: 
Child 3 Name:  Child 3 DOB: 
Child 4 Name:  Child 4 DOB: 

Occupant 1 Information

Name: SSN:
Phone: DOB:
Driver's License #: License State:
Vehicle Make: Year:
Emergency Contact:
Address:
City: State:
Relation: Zip Code:
Phone:  
Present Address:
City: State:
Apt. Complex: Zip Code:
Rate: How Long:
Moving Reason:
Landlord Name: Landlord Phone:
Employer/Income Source:
Address:
City: State:
Monthly Income: Zip Code:
Position: How Long:
Phone: Ext:
Previous Employer:
Address:
City: State:
How Long: Zip Code:

Occupant 2 Information

Name: SSN:
Phone: DOB:
Driver's License #: License State:
Vehicle Make: Year:
Emergency Contact:
Address:
City: State:
Relation: Zip Code:
Phone:  
Present Address:
City: State:
Apt. Complex: Zip Code:
Rate: How Long:
Moving Reason:
Landlord Name: Landlord Phone:
Employer/Income Source:
Address:
City: State:
Monthly Income: Zip Code:
Position: How Long:
Phone: Ext:
Previous Employer:
Address:
City: State:
How Long: Zip Code:
 
 


Seldin Company does not discriminate on the basis of disability status in the admission or access to, or treatment or employment in, its federally assisted programs and activities. The person named below has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development's regulations implementing Section 504 (24 CFR, part 8 dated June 2, 1988).

Bob Dean, 13057 W Center Rd, Omaha NE 68144 Ph. (402)-333-7373