Rental Application

Name *

First Name

Last Name

Requested Move-In Date *

MM

DD

YYYY

Phone *

(###)

###

####

Have you ever been convicted of a crime? *

YES

NO

Current Landlord Name

First Name

Last Name

Current Landlord Phone Number

(###)

###

####

Have you ever been evicted? *

YES

NO

Do you or the prospective occupant smoke? *

YES

NO

Do you or the prospective occupant have a waterbed? *

YES

NO

Do you or the prospective occupant own a pet? *

If yes, please fill out the corresponding fields below.

YES

NO

CAT or DOG?

CAT

DOG

BOTH

Current Employer Phone Number *

(###)

###

####

Is the vehicle registered in New York State? *

YES

NO

Personal Reference #1 Name *

First Name

Last Name

Personal Reference #1 Phone *

(###)

###

####

Personal Reference #2 Name *

First Name

Last Name

Personal Reference #2 Phone *

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Applicant Signature *

Thank you for completing our rental application. I declare that the statements above are true and correct. I herby give authorization to landlord or landlord’s agent to verify all information provided in this application. Permission is granted to interview current and previous landlords, employers to check criminal record, court records, income, bank account and credit information and DMV records. I understand that providing false, misleading information will result in my application being denied.

First Name

Last Name

Date *

MM

DD

YYYY