Green Mountain Real Estate Online Application

If you prefer you can print this application and mail or fax.

199 South Union St #0 - Burlington, VT 05401 - Email:

Applicant's Name:

Applicant's Household (list names of all members that you will rent with)

Street Address:




Home Phone Number:

Mobile Phone Number:

Fax Number (if available):

E-Mail Address:

Driver's License Number:

Social Security Number:

Present Landlord:

Length of Time at Current Address:

Present Landlord's Telephone #:

Previous Landlord:

Previous Landlord's Telephone #:

Your Current Occupation:

Place of Employment (and address):

Employer's (or Supervisor's) Name:

Employer's Telephone Number:

Applicant's Vehicle (Year, Make, Model, License Plate & State)

Have you ever been evicted?

          Yes                  No

Have you failed to pay timely rent?

          Yes                  No

Have you ever filed for bankruptcy?

          Yes                  No

Have you ever convicted for aggravated or sexual assault?

          Yes                  No

Select Apartment(s) that you are Applying for (hold CTRL key for multiple selection)

How did you hear about Green Mountain Real Estate?

Please include any additional information with regard to your application below:


By submitting this application I am authorizing the landlord to conduct an employment and credit check concerning my/our application and to verify all references.  I/We declare that all information listed on this application is true and accurate.