Rental Application Form - Project Binders Real Estate

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Project Binders Real Estate

Asha Rampersad – NY Real Estate Agent

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Rental Application Form

Each adult (18 or older) must fill out a separate application

Name *

First

Last

Birth Date *

Social Security Number *

Driver's License Number *

Any Other Names You Have Used In The Past *

Home Phone

Cell Phone *

All Other Proposed Occupants *

Please list all proposed occupants with birth date and relationship to applicant

Rental/Residence History - Current Residence *

Last Rent Amount Paid *

Owner / Manager and Phone Number *

Reason for Leaving *

Is / Was Rent Paid In Full? *

Yes
No

Did You Give Notice? *

Yes
No

Were you asked to move? *

Yes
No

Name(s) in which your utilities are now billed: *

Dates of Residency *

Rental/Residence History - Previous Residence *

Last Rent Amount Paid *

Owner / Manager and Phone Number *

Reason for Leaving *

Is / Was Rent Paid In Full? *

Yes
No

Did You Give Notice? *

Yes
No

Were you asked to move? *

Yes
No

Name(s) in which your utilities are now billed: *

Dates of Residency *

Rental/Residence History - Prior Residence *

Last Rent Amount Paid *

Owner / Manager and Phone Number *

Reason for Leaving *

Is / Was Rent Paid In Full? *

Yes
No

Did You Give Notice? *

Yes
No

Were you asked to move? *

Yes
No

Name(s) in which your utilities are now billed: *

Dates of Residency *

Employment History - Current Employment *

Employer's Phone *

Occupation *

Name of Supervisor

Monthly Gross Pay *

Dates of Employment *

Employment History - Previous Employment *

Employer's Phone *

Occupation *

Name of Supervisor

Monthly Gross Pay *

Dates of Employment *

Employment History - Prior Employment *

Employer's Phone *

Occupation *

Name of Supervisor

Monthly Gross Pay *

Dates of Employment *

Credit History - Savings Account *

Savings Account - Balance on Deposit or Balance Owed *

Credit History - Checking Account *

Checking Account - Balance on Deposit or Balance Owed *

Credit History - Credit Card *

Credit Card - Balance on Deposit or Balance Owed *

Credit History - Auto Loan *

Auto Loan - Balance on Deposit or Balance Owed *

Vehicles (Include vehicles belonging to other proposed occupants also) *

References & Emergency Contacts - Doctor *

References & Emergency Contacts - Lawyer

References & Emergency Contacts - Nearest Relative Living Elsewhere *

Have you ever been served a late rent notice? *

Yes
No

Do any of the people who would be living in the apartment smoke? *

Yes
No

How long do you think you would be renting from us? *

Have you ever filed bankruptcy? If so when? *

When would you be able to move in? *

Have you ever been convicted of a felony? *

Have you ever been served an eviction notice? If so, when? *

How many pets do you have (list Type, Breed, approx Weight & Age)? *

Have you had any reoccurring problems with your current apartment or landlord? If yes, please explain:

Why are you moving from your current address? *

List any verifiable sources and amounts of income you wish to have considered (optional):

If you were to run into financial difficulty in the future and couldn’t come up with the money to pay the rent, do you know someone that would loan you the money? If so, provide the person’s name, address, & phone # so that we can use them as a reference for you.

Have you been a party to a lawsuit in the past? If yes, please explain why:

We may run a credit check and a criminal background check. Is there anything negative we will find that you want to comment on?

How did you hear about this apartment?

Do you have an e-mail address we can reach you at? *

Do you know of anybody else looking for an apartment? Please provide their name and number. If you refer a friend and you each end up renting separate apartments from us then we will pay you a referral reward.

Agreement & Authorization

I believe that the statements I have made are true and correct. I hereby authorize a credit and/or criminal check to be made, verification of information I provided and communication with any and all names listed on this application. I understand that any discrepancy or lack of information may result in the rejection of this application. I understand that this is an application for an apartment and does not constitute a rental or lease agreement in whole or part. Any questions regarding rejected applications must be submitted in writing and accompanied by a self-addressed stamped envelope.

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NYS HOUSING DISCRIMINATION DISCLOSURE NOTICE & FORM

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