Application Form

Please use the form below to submit a rental application request. This is not a lease agreement, which will be provided upon meeting all requirements of Country Manor Apartments’ rental policy.

There are multiple properties named Country Manor Apartments in the United States.
We are in Leesville, Louisiana.

Bedroom Choice *

1 Bedroom
2 Bedroom

Estimated Move-in Date *

Wheelchair-accessible Unit Required (ADA) *

Lease Duration *

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Applicant's Full Name *

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Date of Birth *

Phone Number *

Social Security Number *

E-mail *

Marital Status *

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Most Recent Permanent Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Driver's License # *

State *

Employer *

Working for How Long *

Type of Work *

Monthly Income Before Taxes *

Work Phone

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Employer's Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Do you have dependents? *

Do you have a vehicle? *

Appears Taxes Working

Do you have a pet? *

Background Information

This information is sought to assure the most responsible residents possible and to assist management in case of emergencies. Your cooperation is appreciated. This information will be kept in confidence.

Why are you leaving your present residence? *

Have you or your spouse ever been evicted? *

Have you or your spouse ever broken a rental agreement / lease contract? *

Have you or your spouse ever been sued for damages to rental property / non-payment of rent? *

Have you or your spouse ever been convicted of a felony? *

Applicant represents that all of the above statements are true and complete and hereby authorizes verification of such information. False information given above shall be grounds for owner’s rejection of the application, forfeit of security deposit and termination of right of occupancy, and it may constitute a serious criminal offense under the laws of this state.

Emergency Contact Information

In case of an emergency whom should we notify?

Name of Emergency Contact *

Emergency Contact Primary Phone *

Emergency Contact E-mail

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Emergency Contact Street Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Advertising Information

To assist Country Manor Apartments with effective advertising, please tell us how you found us.

Payment

Payment method *

I will pay now using ACH
I will pay with cash, check, or money order in the rental office

The security deposit for a 1-bedroom unit is $250. For a 2-bedroom unit, it's $300. Per pet that doesn't live in a cage in the apartment (for instance, cats and dogs), you are obliged to remit an additional $100 deposit.

48 Hour Non-Refundable Security Deposit

Applicant acknowledges that cancellation of move-in more than 48 hours after placing a security deposit to hold an apartment will result in forfeit of the security deposit.

Additional Comments

If there's anything else you would like us to know about you or your application (for example, you are applying with a roommate and/or sharing the security deposit with a second person), please include it here.

Comments

Note: By clicking the "Submit" button below you agree to have the information contained in this form used to determine your eligibility for renting an apartment at Country Manor Apartments.

Application Form