RENTERS


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Rental Application

    RENTAL APPLICATION

    The undersigned hereby makes an application to rent the following property:

    Anticipated move date of at a monthly rent of $ and security deposit of $

    PLEASE TELL US ABOUT YOURSELF

    Full NameHome Phone

    Social Security #Other Phone

    Email Address :

    Co-Applicant Name Home Phone

    Co-Applicant Social Security # Number of Dependants

    Full Names of Dependents

    Full Names of Dependents

    PLEASE GIVE RESIDENTIAL HISTORY (LAST 3 YEARS)

    Current AddressApt#City

    StateZipMonth/Year Moved In

    Reasons for LeavingRent $Owner/Agent

    Phone

    Previous Address (last 3 years)Apt#City

    StateZipMonth/Year Moved In

    Reasons for LeavingRent $Owner/Agent

    Phone

    PLEASE DESCRIBE YOUR CRIMINAL HISTORY

    Have you or anyone in your household ever been convicted of a crime? YesNo

    If yes, please provide a detailed explanation:

    PLEASE DESCRIBE YOUR CREDIT HISTORY

    Have you declared bankruptcy in the past seven (7) years? YesNo

    Have you ever been evicted from a rental residence? YesNo

    Have you had two or more late rental payments in the past year? YesNo

    Have you ever willfully or intentionally refused to pay rent when due? YesNo

    PLEASE PROVIDE YOUR EMPLOYMENT INFORMATION

    Your Status:Full TimePart TimeStudentUnemployed

    Employer

    Dates employedJob Title

    Supervisor Name Phone

    Salary $ per

    (If employed by the above employer for less than 12 months, please provide the name, phone number, and employment dates of previous employer. If you have more than one employer or if there are 2 applicants, please provide the information below.)

    Your Status:Full TimePart Time

    EmployerPhone Dates

    Job Title Supervisor Name Salary $

    per

    Other Sources of Income:

    If you have other sources of income that you would like us to consider, please list income amount, source, and the person (banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application.

    Amount $ Source/Contact Name

    BANKING INFORMATION:

    Banking Accounts:

    NameType of AccountAccount Number

    Type of AccountAccount NumberPERSONAL REFERENCE OR EMERGENCY CONTACT:

    NameAddress

    Phone Relationship

    Driver's License:

    Your Driver's License NumberState

    Vehicle Information:

    Make / Model Year License Plate State

    ADDITIONAL INFORMATION

    Please give any additional information that might help owner/management evaluate this application?

    Where may we reach you to discuss this application?

    Daytime Phone # Evening Phone #

    Security Deposit:

    I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and agree that the rental is to be payable the first day of each month in advance. As an inducement to the owner of the property and to the agent to accept this application, I warrant that all statements above set forth are true; however, should any statement made above be a misrepresentation or not a true statement of facts, all of the deposit will be retained to offset the agent's cost, time, and effort in processing my application.

    I hereby deposit $ as earnest money to be refunded to me if this application is not accepted in 5 business banking days. Upon acceptance, this deposit shall be retained as the security deposit for the term of the lease. When so approved and accepted, I agree to execute a lease for 12 months once possession is given; otherwise security deposit will be forfeited. Lessee must give proper notice to vacate, as required in lease by NY state law. (30 days notice). If proper notice is not received security deposit will be forfeited.

    The $20.00 application processing fee is NON-REFUNDABLE. The applicant is hereby waiving any claim for damages by reason of non-acceptance which the owner or agent may reject. I recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared whereby information is obtained through credit check, background check and personal interviews with others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living.

    All of the above information, to the best of my knowledge, is true and correct.

    Name of ApplicantDate

    AUTHORIZATION (Release of Information)

    I authorize an investigation of my credit, tenant history, banking and employment for the purposes of renting a house, apartment, or condominium from this owner/manager.

    Name:

    Signature

    Date