Residential Rental Application APPLICANT INFORMATIONName(Required) First Last Date of Birth(Required) Social Security #(Required) Phone(Required)Tenant Email Address(Required) Address of Rental Property(Required) Street Address Address Line 2 City ZIP Code Desired date of occupancy(Required) Desired length of occupancy(Required) RENTAL HISTORYPresent Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long at present address(Required) Home Phone No(Required)Current rent payment(Required) Reason for moving(Required) Landlord's Name(Required) Landlord's Phone No(Required)Prior Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long at prior address Current rent payment - Prior Address Reason for moving - Prior Address Landlord's Name - Prior Address Landlord's Phone No - Prior AddressADDITIONAL OCCUPANT INFORMATION (if applicable)Name of Spouse First Last Date of Birth - Spouse Social Security# Phone #NAMES OF OTHER TENANTS, INCLUDING ANYONE WHO WILL LIVE WITH YOU (EVEN ON A TEMPORARY BASIS)No. of occupants:(Required)1234Name First Last Present Address: Home Phone No.:How long at present address: Relationship: Occupation: School: TENANT 2Name First Last Present Address: Home Phone No.:How long at present address: Relationship: Occupation: School: TENANT 3Name First Last Present Address: Home Phone No.:How long at present address: Relationship: Occupation: School: TENANT 4Name First Last Present Address: Home Phone No.:How long at present address: Relationship: Occupation: School: IF A SECOND ADULT WILL BE RENTING THE PREMISES, THEY MAY NEED TO COMPLETE A SEPARATE RENTAL APPLICATION FORM.VEHICLESVehicle Model: Year: License No.: Vehicle Model: Year: License No.: PETSDo you have pets(Required) Yes No Name: Type/Breed: Size: Name: Type/Breed: Size: MISCELLANEOUSWater bed:(Required) Yes No Smokers:(Required) Yes No Do you own real estate? Yes No If yes, please explain where: Have you ever been evicted from any rental premises?(Required) Yes No If yes, please explain where: Have you ever willfully and intentionally refused to pay rent when due?(Required) Yes No If yes, please explain where: Have you ever been convicted of a felony?(Required) Yes No If yes, please explain where: CURRENT EMPLOYER:Employer:(Required) Business Phone:Position: How long: Supervisor: Annual Income: Other Income sources: Gov't assistance $ Other $ Child support/Alimony$ ADDITIONAL OCCUPANT’S EMPLOYER:Employer: Business Phone:Position: How long: Supervisor: Annual Income: Other Income sources: Gov't assistance $ Other $ Child support/Alimony$ NEAREST RELATIVE NOT LIVING WITH YOU:Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Relationship:(Required) Home Phone No.:(Required)CREDIT/PROFESSIONAL REFERENCES (Non-related):Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone No.:(Required)Relationship:(Required) Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone No.:(Required)Relationship:(Required) Consent Please check below to acknowledge receipt of this disclosure. The below will be emailed to you.New York State Housing and Anti-Discrimination Disclosure Form Federal, State and local Fair Housing Laws provide comprehensive protections from discrimination in housing. It is unlawful for any property owner, landlord, property manager or other person who sells, rents or leases housing, to discriminate based on certain protected characteristics, which include, but are not limited to race, creed, color, national origin, sexual orientation, gender identity or expression, military status, sex, age, disability, marital status, lawful source of income or familial status. Real estate professionals must also comply with all Fair Housing Laws. Real estate brokers and real estate salespersons, and their employees and agents violate the Law if they: • Discriminate based on any protected characteristic when negotiating a sale, rental or lease, including representing that a property is not available when it is available. • Negotiate discriminatory terms of sale, rental or lease, such as stating a different price because of race, national origin or other protected characteristic. • Discriminate based on any protected characteristic because it is the preference of a seller or landlord. • Discriminate by “steering” which occurs when a real estate professional guides prospective buyers or renters towards or away from certain neighborhoods, locations or buildings, based on any protected characteristic. • Discriminate by “blockbusting” which occurs when a real estate professional represents that a change has occurred or may occur in future in the composition of a block, neighborhood or area, with respect to any protected characteristics, and that the change will lead to undesirable consequences for that area, such as lower property values, increase in crime, or decline in the quality of schools. • Discriminate by pressuring a client or employee to violate the Law. • Express any discrimination because of any protected characteristic by any statement, publication, advertisement, application, inquiry or any Fair Housing Law record. YOU HAVE THE RIGHT TO FILE A COMPLAINT If you believe you have been the victim of housing discrimination you should file a complaint with the New York State Division of Human Rights (DHR). Complaints may be filed by: • Downloading a complaint form from the DHR website: www.dhr.ny.gov; • Stop by a DHR office in person, or contact one of the Division’s offices, by telephone or by mail, to obtain a complaint form and/or other assistance in filing a complaint. A list of office locations is available online at: https://dhr.ny.gov/contact-us, and the Fair Housing HOTLINE at (844)-862-8703. You may also file a complaint with the NYS Department of State, Division of Licensing Services. Complaints may be filed by: • Downloading a complaint form from the Department of State’s website https://www.dos.ny.gov/licensing/complaint_links.html • Stop by a Department’s office in person, or contact one of the Department’s offices, by telephone or by mail, to obtain a complaint form. • Call the Department at (518) 474-4429. There is no fee charged to you for these services. It is unlawful for anyone to retaliate against you for filing a complaint. Landlord does not discriminate against any applicant on the basis of an illegal purpose including, race, color, religion, sex, national origin, age, disability or family status. Such discrimination as the sole basis of refusal to rent is illegal throughout the United States. Local or State laws may provide additional protected classes from discrimination. You can call the U.S. Department of Housing and Urban Development (HUD) at 1-800-424-8590 to ask questions about discrimination. I represent that the information provided in this Application is true and correct to the best of my knowledge. I understand that this Application is not a rental agreement and that this Application does not create any obligation on the Landlord. I understand that the information provided might be used by Landlord or Landlord’s Property Manager, to determine whether to accept this Application. I authorize Landlord or Landlord’s property manager to verify all the information given in this application, including banking and personal references and employment information provided. I also authorize Landlord or Landlord’s Property Manager to perform a credit check and a criminal history check. I consent to the release of information relating to my credit and the information provided in this application. Applicant's Signature(Required)Date(Required) Spouse/Co-Applicant's SignatureDate CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
