RENTAL APPLICATION AND AGREEMENT

This request is for property invitation and eventual lease (Please Print)

NAME :_______________________________________________
 *Date ________________

SOCIAL SECURITY NO. _________________________________ preferred

PRESENT ADDRESS PRESENT:

HOME / STREET: _________________________________ TOWN: ___________________

STATE:___________________________________ ZIP:______________________________

PHONE: _________________________________ CELL / TEXT: _____________________

PRIMARY EMAIL: __________________________________________________________

SECONDARY EMAIL: _______________________________________________________

Current or previous information / experience:

*APARTMENT NO: ______________
*SECURITY DEPOSIT $______________________

* PET DEPOSIT $ ____________________________________________________________

* CLEANING DEPOSIT $ ______________________________________________________

*MONTHLY RENTAL $_________________________________________________________

RENTAL INSURANCE (preferred) : (CIRCLE) YES NO

IF YES - CARRIER _________________________________________________________

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BUSINESS: (circle) FULL TIME PART TIME SELF EMPLOYED STUDENT RETIRED

OCCUPATION: _______________________________________________________________

OCCUPATION DATE: ____________________ HOW LONG: _________________________

PRESENT EMPLOYER: _________________________________________________________

EMPLOYER CONTACT: ________________________________________________________

ADDRESS OF EMPLOYER: _____________________________________________________

LENGTH OF TIME: ____________________________________________________________

PHONE: _____________________________________________________________________

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SPOUSE AND/OR 2ND RESPONSIBLE PERSON

NAME: _______________________________________________________________________

SOCIAL SECURITY NO. : ________________________________________________________

FORMER NAME: _______________________________________________________________

PHONE: (IF DIFFERENT) ________________________________________________________

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SPOUSE'S EMPLOYER AND/OR 2ND RESPONSIBLE PERSONS EMPLOYER

______________________________________________________________________

EMPLOYER ADDRESS: ________________________________________________

LENGTH OF TIME: ___________________________________

EMPLOYER PHONE: __________________________________________________

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PRESENT LANDLORD ADDRESS: _______________________________________

______________________________________________________________________

PHONE: ______________________________________________________________

REASON FOR LEAVING CURRENT RESIDENCE : ___________________________

________________________________________________________________________

IF NO LANDLORD, LAST ADDRESS AND RESIDENCE NEAREST LIVING RELATIVE:

___________________________________________________________________________

___________________________________________________________________________

PHONE: ___________________________________________________________________

EMAIL: ____________________________________________________________________

ADDRESS OF NEAREST LIVING RELATIVE :__________________________________

__________________________________________________________________________

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PERSONS WHO WILL OCCUPY HOME /APARTMENT (NAME, AGE AND RELATIONSHIP)

NAME: __________________________________________________________________

AGE: ___________________ RELATIONSHIP_________________________________

NAME: __________________________________________________________________

AGE: ___________________ RELATIONSHIP_________________________________

NAME: __________________________________________________________________

AGE: ___________________ RELATIONSHIP_________________________________

NAME: __________________________________________________________________

AGE: ___________________ RELATIONSHIP_________________________________

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VEHICLES: HOW MANY? (no more than 2 cars, or 1 car 1 truck or 2 trucks)

additional vehicles maybe allowed but with storage fee

CAR ______________ TRUCK _____________ CAMPER ___________

BOAT _________________________ MOTOR HOME __________________________

CAR MAKE & MODEL: _________________________________________________

YEAR: ___________________ LICENSE #: _________________________

PLATE # _________________________________________________________

CAR MAKE & MODEL: _________________________________________________

YEAR: ___________________ LICENSE #: _________________________

PLATE # _________________________________________________________

TRUCK MAKE & MODEL: _________________________________________________

YEAR: ___________________ LICENSE #: _________________________

PLATE # _________________________________________________________

TRUCK MAKE & MODEL: _________________________________________________

YEAR: ___________________ LICENSE #: _________________________

PLATE # _________________________________________________________

CAMPER / BOAT OR MOTOR HOME -

MAKE & MODEL: _________________________________________________

YEAR: ___________________ LICENSE #: _________________________

PLATE # _________________________________________________________

CAMPER / BOAT OR MOTOR HOME -

MAKE & MODEL: _________________________________________________

YEAR: ___________________ LICENSE #: _________________________

PLATE # _______________________________________________________

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PETS ALLOWED - HOW MANY - (pet policy: 1 dog, 1 or 2 cats, or 1 dog & 1 cat )

Applicant must show active dog license, heath, rabies certificates.

NO EXOTICS. DOGS LIMITED BY BREED.

CAT __________________ DOG __________________ BIRD ______________

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CREDIT INFORMATION - FOR SECURITY ONLY

BANK: _______________________________________________________________

CHECKING ACCOUNT NO: ____________________________________________

SAVINGS ACCOUNT NO.______________________________________________

BANK: _____________________________________________________________

CHECKING ACCOUNT NO.____________________________________________

SAVINGS ACCOUNT NO . _____________________________________________

CREDIT CARD TYPE: (circle) VISA MASTERCARD DISCOVER PAYPAL

EXPIRATION DATE: ___________________________________________________

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LIST FOUR CREDIT REFERENCES: (PREFERRED)

NAME: ____________________________________________ ACCOUNT NO

.

NAME: _____________________________________________ACCOUNT NO.

NAME: _____________________________________________ACCOUNT NO

NAME: _____________________________________________ACCOUNT NO.

Submit / Send: attn: cher 4504 South Creek LLC, PO box 252, Palmyra, NY 14522 - scnop@aol.com