Applicant name *

First Name

Last Name

Your name *

First Name

Last Name

Phone *

(###)

###

####

Does the applicant smoke? (Cigarettes, marijuana, cigars, vaping included) *

Yes - inside and outside

Yes - outside only

The applicant does not smoke.

I'm unsure whether the applicant smokes.

Do you know of any instances in which applicant has damaged property or caused conflict with neighbors? *

No

Yes