Please list three personal references and their relationship to you:

 

 

Your Home

 

Address______________________________________________________   Apt. #  ____________

City     _______________________     State   ________________________   Zip   _____________

 

Home phone  _____________________     Work Phone   _________________________________

E-mail address  _______________________________________  FAX   _____________________

 

Do you own or rent your home?  _____________________________________________________

 

Is your home a:    5  single home,         5  apartment,          5  duplex,         5  townhouse,         

                                        5  mobile home,              5  other  _____________________      

 

Are there any community restrictions to cats?   Yes  5          No  5

    If yes, please explain.   ___________________________________________________________

 

If you rent, do you have written permission from your landlord to have a cat?   Yes  5        No  5

Landlord name   _______________________________  Landlord phone  ____________________

 

How long have you been at your present address?  _______________________________________

 

Are you planning to move within the next 6 months?       Yes  5              No  5

 

Will all of your companion animals go with you if you move?    Yes  5            No  5

 

Is anyone in your home allergic to cats?    Yes  5        No  5

  If yes, please explain.   _________________________________________________________