Click here to start customizing
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8" />
<meta name="viewport" content="width=device-width, initial-scale=1.0" />
<title>Hammonia, LLC Rental Application</title>
<style>
:root {
--blue: #174f78;
--light-blue: #e8f2f8;
--border: #c9d3dc;
--text: #1f2933;
--muted: #5d6975;
--bg: #ffffff;
}
* { box-sizing: border-box; }
body {
margin: 0;
font-family: Arial, Helvetica, sans-serif;
color: var(--text);
background: #f5f7fa;
line-height: 1.45;
}
.application-wrap {
max-width: 980px;
margin: 0 auto;
padding: 24px;
}
.application-card {
background: var(--bg);
border: 1px solid var(--border);
border-radius: 12px;
box-shadow: 0 4px 20px rgba(0,0,0,.06);
overflow: hidden;
}
.header {
text-align: center;
padding: 28px 24px 18px;
border-bottom: 1px solid var(--border);
}
.header h1 {
margin: 0 0 6px;
color: var(--blue);
font-size: 28px;
letter-spacing: .5px;
}
.header h2 {
margin: 10px 0 8px;
font-size: 24px;
}
.header p {
margin: 4px 0;
font-size: 14px;
}
form { padding: 22px; }
.notice {
background: #fff7e6;
border: 1px solid #f2ce8c;
border-radius: 8px;
padding: 14px;
margin-bottom: 18px;
font-size: 14px;
}
.section {
margin: 22px 0;
border: 1px solid var(--border);
border-radius: 8px;
overflow: hidden;
}
.section-title {
background: var(--blue);
color: #fff;
padding: 9px 12px;
font-weight: 700;
text-transform: uppercase;
letter-spacing: .2px;
}
.section-body {
padding: 14px;
}
.help {
color: var(--muted);
font-size: 13px;
margin: 0 0 12px;
font-style: italic;
}
.grid {
display: grid;
grid-template-columns: repeat(2, minmax(0, 1fr));
gap: 12px 16px;
}
.grid-3 {
display: grid;
grid-template-columns: repeat(3, minmax(0, 1fr));
gap: 12px;
}
.grid-4 {
display: grid;
grid-template-columns: repeat(4, minmax(0, 1fr));
gap: 12px;
}
.full { grid-column: 1 / -1; }
label {
display: block;
font-weight: 700;
font-size: 13px;
margin-bottom: 4px;
}
input[type="text"], input[type="email"], input[type="tel"], input[type="date"], input[type="number"], textarea, select {
width: 100%;
border: 1px solid var(--border);
border-radius: 6px;
padding: 10px;
font-size: 15px;
background: #fff;
}
textarea {
min-height: 90px;
resize: vertical;
}
fieldset {
border: 1px solid var(--border);
border-radius: 8px;
padding: 12px;
margin: 10px 0;
}
legend {
font-weight: 700;
padding: 0 6px;
}
.checks {
display: grid;
grid-template-columns: repeat(2, minmax(0, 1fr));
gap: 8px 14px;
margin-top: 8px;
}
.check {
display: flex;
align-items: flex-start;
gap: 8px;
font-weight: 400;
font-size: 14px;
}
.check input { margin-top: 3px; }
.repeat-box {
border: 1px solid var(--border);
background: #fbfdff;
border-radius: 8px;
padding: 12px;
margin: 12px 0;
}
.repeat-title {
font-weight: 700;
margin-bottom: 10px;
color: var(--blue);
}
.certification {
background: var(--light-blue);
border: 1px solid var(--border);
border-radius: 8px;
padding: 14px;
margin-top: 14px;
}
button {
background: var(--blue);
color: #fff;
border: 0;
padding: 14px 22px;
border-radius: 8px;
font-size: 16px;
font-weight: 700;
cursor: pointer;
}
button:hover { filter: brightness(.95); }
.small {
font-size: 12px;
color: var(--muted);
}
@media (max-width: 760px) {
.application-wrap { padding: 10px; }
form { padding: 14px; }
.grid, .grid-3, .grid-4, .checks {
grid-template-columns: 1fr;
}
}
</style>
</head>
<body>
<div class="application-wrap">
<div class="application-card">
<div class="header">
<h1>HAMMONIA, LLC</h1>
<p>Villa Theresa Apartments</p>
<p>204 N Main Street, O’Fallon, MO 63366</p>
<p>PO BOX 62, O’Fallon, MO 63366</p>
<p>Phone: (636) 699-0069 | Fax: (636) 410-3339</p>
<p>hammoniallc@gmail.com</p>
<h2>Rental Application and Compliance Questionnaire</h2>
<p><em>Completion of this application does not guarantee approval or unit availability.</em></p>
</div>
<form action="https://formsubmit.co/hammoniallc@gmail.com" method="POST">
<input type="hidden" name="_subject" value="New Hammonia Rental Application from Website" />
<input type="hidden" name="_template" value="table" />
<input type="hidden" name="_captcha" value="false" />
<div class="notice">
<strong>Equal Housing / Important Notice:</strong> Hammonia, LLC is committed to fair housing and equal opportunity. Applications are processed consistently and without regard to race, color, religion, sex, national origin, disability, familial status, or any other protected class under applicable law. Applicants may request a reasonable accommodation or modification at any time.<br><br>
<strong>Privacy note:</strong> Do not submit Social Security numbers, bank statements, account documents, photo IDs, or other sensitive records through this form. Staff will provide a secure method or in-person process when documents are needed.
</div>
<div class="section">
<div class="section-title">1. Primary Applicant Information</div>
<div class="section-body grid">
<div><label for="full_name">Full Legal Name *</label><input id="full_name" name="Primary Applicant - Full Legal Name" type="text" required></div>
<div><label for="dob">Date of Birth *</label><input id="dob" name="Primary Applicant - Date of Birth" type="date" required></div>
<div><label for="phone">Phone *</label><input id="phone" name="Primary Applicant - Phone" type="tel" required></div>
<div><label for="email">Email *</label><input id="email" name="Primary Applicant - Email" type="email" required></div>
<div><label for="current_address">Current Address *</label><input id="current_address" name="Primary Applicant - Current Address" type="text" required></div>
<div><label for="city_state_zip">City/State/ZIP *</label><input id="city_state_zip" name="Primary Applicant - City/State/ZIP" type="text" required></div>
<div class="full"><label for="mailing_address">Mailing Address, if Different</label><input id="mailing_address" name="Primary Applicant - Mailing Address if Different" type="text"></div>
<div>
<label for="contact_method">Best Contact Method</label>
<select id="contact_method" name="Primary Applicant - Best Contact Method">
<option value="">Select one</option>
<option>Phone</option>
<option>Email</option>
<option>Mail</option>
<option>Text</option>
</select>
</div>
<div><label for="id_type">Government ID Type</label><input id="id_type" name="Primary Applicant - Government ID Type" type="text"></div>
<div class="full"><label for="id_state_number">ID State / Number</label><input id="id_state_number" name="Primary Applicant - ID State/Number" type="text"></div>
</div>
</div>
<div class="section">
<div class="section-title">2. Co-Applicant / Additional Adult Information</div>
<div class="section-body">
<p class="help">List additional adults. Do not enter Social Security numbers in this form.</p>
<div class="repeat-box">
<div class="repeat-title">Additional Adult 1</div>
<div class="grid-3">
<div><label>Name</label><input name="Additional Adult 1 - Name" type="text"></div>
<div><label>Relationship</label><input name="Additional Adult 1 - Relationship" type="text"></div>
<div><label>Date of Birth</label><input name="Additional Adult 1 - DOB" type="date"></div>
<div><label>Phone</label><input name="Additional Adult 1 - Phone" type="tel"></div>
<div><label>Email</label><input name="Additional Adult 1 - Email" type="email"></div>
<div><label>ID/SSN Collected Securely?</label><select name="Additional Adult 1 - ID/SSN Collected Securely"><option></option><option>Yes</option><option>No</option><option>Pending</option></select></div>
</div>
</div>
<div class="repeat-box">
<div class="repeat-title">Additional Adult 2</div>
<div class="grid-3">
<div><label>Name</label><input name="Additional Adult 2 - Name" type="text"></div>
<div><label>Relationship</label><input name="Additional Adult 2 - Relationship" type="text"></div>
<div><label>Date of Birth</label><input name="Additional Adult 2 - DOB" type="date"></div>
<div><label>Phone</label><input name="Additional Adult 2 - Phone" type="tel"></div>
<div><label>Email</label><input name="Additional Adult 2 - Email" type="email"></div>
<div><label>ID/SSN Collected Securely?</label><select name="Additional Adult 2 - ID/SSN Collected Securely"><option></option><option>Yes</option><option>No</option><option>Pending</option></select></div>
</div>
</div>
</div>
</div>
<div class="section">
<div class="section-title">3. Household Composition</div>
<div class="section-body">
<p class="help">List every person who will live in the unit, including minors, temporary household members, and live-in aides.</p>
<textarea name="Household Composition" placeholder="For each person: Full name, relationship, DOB, age, full-time student yes/no, disabled optional, will live in unit yes/no"></textarea>
</div>
</div>
<div class="section">
<div class="section-title">4. Student Status - LIHTC Required Questions</div>
<div class="section-body">
<fieldset>
<legend>Is every household member a full-time student, or expected to be a full-time student, for any part of five months during the current calendar year?</legend>
<label class="check"><input type="radio" name="Every Household Member Full-Time Student" value="Yes"> Yes</label>
<label class="check"><input type="radio" name="Every Household Member Full-Time Student" value="No"> No</label>
</fieldset>
<fieldset>
<legend>If yes, does one of the LIHTC student exceptions apply?</legend>
<div class="checks">
<label class="check"><input type="checkbox" name="Student Exception[]" value="TANF assistance"> TANF assistance</label>
<label class="check"><input type="checkbox" name="Student Exception[]" value="Job Training/WIOA-type program"> Job Training/WIOA-type program</label>
<label class="check"><input type="checkbox" name="Student Exception[]" value="Single parent with children"> Single parent with child(ren), not claimed by another taxpayer</label>
<label class="check"><input type="checkbox" name="Student Exception[]" value="Married eligible joint tax return"> Married and eligible to file joint tax return</label>
<label class="check"><input type="checkbox" name="Student Exception[]" value="Former foster care"> Former foster care</label>
<label class="check"><input type="checkbox" name="Student Exception[]" value="Other"> Other approved exception</label>
</div>
<label for="student_other">Other / explanation</label>
<textarea id="student_other" name="Student Status Explanation"></textarea>
</fieldset>
</div>
</div>
<div class="section">
<div class="section-title">5. Current and Prior Housing History</div>
<div class="section-body">
<textarea name="Housing History" placeholder="For each address: Address, landlord/manager, phone/email, dates lived there, monthly rent, reason for leaving, notice given"></textarea>
</div>
</div>
<div class="section">
<div class="section-title">6. Employment and Income Information</div>
<div class="section-body">
<p class="help">List all income expected for the next 12 months for every adult household member and any unearned income for minors.</p>
<textarea name="Employment and Income Information" placeholder="For each source: Household member, employer/income source, start date, gross amount, frequency, verification contact, expected to continue yes/no"></textarea>
<fieldset>
<legend>Other income sources for anyone in the household</legend>
<div class="checks">
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="Social Security/SSI/SSDI"> Social Security/SSI/SSDI</label>
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="Pension/Retirement"> Pension/Retirement</label>
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="VA benefits"> VA benefits</label>
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="Unemployment"> Unemployment</label>
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="Child support"> Child support</label>
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="Alimony"> Alimony</label>
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="Regular family contributions"> Regular family contributions</label>
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="Self-employment"> Self-employment</label>
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="Gig work"> Gig work</label>
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="Public assistance"> Public assistance</label>
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="Student financial aid"> Student financial aid</label>
<label class="check"><input type="checkbox" name="Other Income Sources[]" value="Trust income"> Trust income</label>
</div>
<label for="other_income">Other income source</label>
<input id="other_income" name="Other Income Source - Other" type="text">
</fieldset>
</div>
</div>
<div class="section">
<div class="section-title">7. Assets</div>
<div class="section-body">
<p class="help">Include accounts even if the balance is low. Do not upload statements through this form.</p>
<textarea name="Assets" placeholder="For each asset: Household member, asset type, institution/description, account last 4 digits only, current balance/value, annual income from asset, verification needed"></textarea>
<fieldset>
<legend>Has any household member sold, transferred, gifted, or disposed of an asset for less than fair market value in the last two years?</legend>
<label class="check"><input type="radio" name="Disposed Asset Less Than Fair Market Value" value="Yes"> Yes</label>
<label class="check"><input type="radio" name="Disposed Asset Less Than Fair Market Value" value="No"> No</label>
<label for="disposed_explain">If yes, explain</label>
<textarea id="disposed_explain" name="Disposed Asset Explanation"></textarea>
</fieldset>
<fieldset>
<legend>Does any household member own or have an ownership interest in real estate?</legend>
<label class="check"><input type="radio" name="Owns Real Estate" value="Yes"> Yes</label>
<label class="check"><input type="radio" name="Owns Real Estate" value="No"> No</label>
<label for="real_estate_explain">If yes, explain</label>
<textarea id="real_estate_explain" name="Real Estate Ownership Explanation"></textarea>
</fieldset>
</div>
</div>
<div class="section">
<div class="section-title">8. Accessibility / Reasonable Accommodation</div>
<div class="section-body">
<fieldset>
<legend>Do you need a unit with accessibility features?</legend>
<div class="checks">
<label class="check"><input type="checkbox" name="Accessibility Features[]" value="No"> No</label>
<label class="check"><input type="checkbox" name="Accessibility Features[]" value="No-step entry"> No-step entry</label>
<label class="check"><input type="checkbox" name="Accessibility Features[]" value="Grab bars"> Grab bars</label>
<label class="check"><input type="checkbox" name="Accessibility Features[]" value="Lower counters"> Lower counters</label>
<label class="check"><input type="checkbox" name="Accessibility Features[]" value="Visual/hearing features"> Visual/hearing features</label>
</div>
<label for="access_other">Other</label>
<input id="access_other" name="Accessibility Features - Other" type="text">
</fieldset>
<fieldset>
<legend>Do you want to request a reasonable accommodation or modification?</legend>
<label class="check"><input type="radio" name="Reasonable Accommodation Requested" value="No"> No</label>
<label class="check"><input type="radio" name="Reasonable Accommodation Requested" value="Yes"> Yes</label>
</fieldset>
<label for="communication_assistance">Preferred communication assistance, if any</label>
<textarea id="communication_assistance" name="Preferred Communication Assistance"></textarea>
</div>
</div>
<div class="section">
<div class="section-title">9. Screening Information</div>
<div class="section-body">
<fieldset>
<legend>Have you or any adult household member ever been evicted, had an eviction filed, or owed money to a landlord?</legend>
<label class="check"><input type="radio" name="Eviction or Landlord Debt" value="Yes"> Yes</label>
<label class="check"><input type="radio" name="Eviction or Landlord Debt" value="No"> No</label>
<label for="eviction_explain">If yes, explain</label>
<textarea id="eviction_explain" name="Eviction or Landlord Debt Explanation"></textarea>
</fieldset>
<fieldset>
<legend>Have you or any adult household member ever been convicted of a crime that may be relevant under the property’s written screening criteria?</legend>
<label class="check"><input type="radio" name="Relevant Criminal Conviction" value="Yes"> Yes</label>
<label class="check"><input type="radio" name="Relevant Criminal Conviction" value="No"> No</label>
<label for="conviction_explain">If yes, explain</label>
<textarea id="conviction_explain" name="Relevant Criminal Conviction Explanation"></textarea>
</fieldset>
<fieldset>
<legend>Are you or any household member subject to a lifetime sex offender registration requirement?</legend>
<label class="check"><input type="radio" name="Lifetime Sex Offender Registration" value="Yes"> Yes</label>
<label class="check"><input type="radio" name="Lifetime Sex Offender Registration" value="No"> No</label>
</fieldset>
<fieldset>
<legend>Do you have any pets or assistance animals?</legend>
<label class="check"><input type="radio" name="Pets or Assistance Animals" value="No"> No</label>
<label class="check"><input type="radio" name="Pets or Assistance Animals" value="Pet(s)"> Pet(s)</label>
<label class="check"><input type="radio" name="Pets or Assistance Animals" value="Assistance animal accommodation request"> Assistance animal accommodation request</label>
<label for="pets_details">Details</label>
<textarea id="pets_details" name="Pets or Assistance Animals Details"></textarea>
</fieldset>
<div class="grid-4">
<div><label>Vehicle Make/Model</label><input name="Vehicle 1 - Make/Model" type="text"></div>
<div><label>Plate</label><input name="Vehicle 1 - Plate" type="text"></div>
<div><label>State</label><input name="Vehicle 1 - State" type="text"></div>
<div><label>Second Vehicle</label><input name="Second Vehicle" type="text"></div>
</div>
</div>
</div>
<div class="section">
<div class="section-title">10. Emergency Contact</div>
<div class="section-body grid">
<div><label>Name</label><input name="Emergency Contact - Name" type="text"></div>
<div><label>Relationship</label><input name="Emergency Contact - Relationship" type="text"></div>
<div><label>Phone</label><input name="Emergency Contact - Phone" type="tel"></div>
<div><label>Email</label><input name="Emergency Contact - Email" type="email"></div>
<div class="full"><label>Address</label><input name="Emergency Contact - Address" type="text"></div>
<div class="full">
<fieldset>
<legend>May we contact before move-in?</legend>
<label class="check"><input type="radio" name="May Contact Emergency Contact Before Move-In" value="Yes"> Yes</label>
<label class="check"><input type="radio" name="May Contact Emergency Contact Before Move-In" value="No"> No</label>
</fieldset>
</div>
</div>
</div>
<div class="section">
<div class="section-title">11. Authorization to Verify Information</div>
<div class="section-body">
<p>I/We authorize Hammonia, LLC and its agents to verify the information provided in this application, including rental history, employment, income, assets, student status, references, credit, criminal background, public records, and other eligibility information needed for affordable housing compliance and leasing decisions. I/We understand that additional third-party verification forms may be required before final approval.</p>
<p><strong>I/We certify that the information provided is true and complete to the best of my/our knowledge. I/We understand that false, incomplete, or misleading information may result in denial, cancellation of approval, termination of tenancy, or other action allowed by law and program rules.</strong></p>
<div class="certification">
<label class="check"><input type="checkbox" name="Applicant Certification" value="Agreed" required> I agree to the authorization and certification above. *</label>
</div>
</div>
</div>
<div class="section">
<div class="section-title">12. Applicant Signature</div>
<div class="section-body grid">
<div><label for="signature_name">Typed Applicant Name *</label><input id="signature_name" name="Typed Applicant Signature" type="text" required></div>
<div><label for="signature_date">Date *</label><input id="signature_date" name="Signature Date" type="date" required></div>
<div class="full small">Typing your name and submitting this form is intended to serve as your electronic signature for application intake purposes.</div>
</div>
</div>
<div class="section">
<div class="section-title">Document Checklist for LIHTC Review</div>
<div class="section-body">
<p class="help">Staff may request documents after the application is reviewed. Do not submit sensitive documents through this form unless Hammonia provides a secure upload method.</p>
<div class="checks">
<label class="check"><input type="checkbox" name="Applicant Acknowledges Documents May Be Requested[]" value="Government-issued photo ID"> Government-issued photo ID for each adult household member</label>
<label class="check"><input type="checkbox" name="Applicant Acknowledges Documents May Be Requested[]" value="Identity documentation collected securely"> Social Security card/ITIN documentation or other permitted identity documentation, collected securely</label>
<label class="check"><input type="checkbox" name="Applicant Acknowledges Documents May Be Requested[]" value="Proof of age for minors"> Birth certificates or acceptable proof of age for minors, if required by policy</label>
<label class="check"><input type="checkbox" name="Applicant Acknowledges Documents May Be Requested[]" value="Pay stubs/employer verification"> Most recent 4-6 consecutive pay stubs for each job, or employer verification</label>
<label class="check"><input type="checkbox" name="Applicant Acknowledges Documents May Be Requested[]" value="Benefit letters"> Social Security/SSI/SSDI, pension, VA, unemployment, or public assistance letters</label>
<label class="check"><input type="checkbox" name="Applicant Acknowledges Documents May Be Requested[]" value="Bank/account statements"> Current bank/account statements</label>
<label class="check"><input type="checkbox" name="Applicant Acknowledges Documents May Be Requested[]" value="Student status verification"> Student status verification</label>
<label class="check"><input type="checkbox" name="Applicant Acknowledges Documents May Be Requested[]" value="Real estate documents"> Real estate documents, if applicable</label>
</div>
</div>
</div>
<button type="submit">Submit Application</button>
<p class="small">After adding this to your website, submit one test application first. FormSubmit may require you to confirm the hammoniallc@gmail.com email address before live submissions begin.</p>
</form>
</div>
</div>
</body>
</html>