Roommate Application

Most occupants are required to complete the complete residential application here: https://floridalandgroup.com/rent/apply. Complete the application below only if you have been requested to do so by the Lessor. The roommate application fee is $75 and can be paid by bank draft or credit card. See www.floridalandgroup.com/resources to select the payment option of your choice.

 

Full Name
Primary Email
Secondary Email
Mobile / Primary Phone
Secondary Phone
Current Address - Number, Street, City, State / Province, Zip, Country
Drivers License Number or National ID Number
Date of Birth (dd/mm/yyyy)
Emergency Contact Person, Relationship, Phone
Have you ever been evicted or refused to pay rent? (Explain yes in comments)
Have you been convicted or a felony? (Explain yes in comments)
Vehicle year, make, model
Comments
Electronic Signature - Type Full Name
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