TITUS PROPERTIES
Mail to P.O. Box 467, Gold Beach OR 97444
or FAX to 541-247-2859
Ph: 541-247-4747

Name____________________________________________________________________________
Last First Middle

Date of Birth________________SS#_____________________Dr. Lic. #_______________St._____

Address__________________________________________________________________________

Phone_______________________Cell____________________Mo. Income____________________
Employer_________________________________________________________________________
Name Address Phone

Spouse____________________________________________________________________________
Last First Middle

Date of Birth________________SS#_____________________Dr. Lic. #_______________St._____

Address__________________________________________________________________________

Phone_______________________Cell____________________Mo. Income____________________

Employer_________________________________________________________________________
Name Address Phone
Current landlord________________________________Ph________________Fax______________
Reason for moving_________________________________________________________________
Previous landlord ________________________________Ph________________Fax_____________
Reference_________________________________________________________________________
Reference (relative)_________________________________________________________________

Vehicles to be kept at unit____________________________________________________________

Names and ages of minor children staying in unit__________________________________________
_________________________________________________________________________________

Have you, your spouse, or any applicant listed above ever been convicted of a felony, violent crime or is
required to register as a sex offender? If yes, please explain below
____________________________________________________________________________

The undersigned (all adult tenants must sign) hereby attests that above information is true and authorizes
verification of any or all information given.

Name__________________________________________________________Date______________

Name___________________________________________________________Date______________