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RENTAL APPLICATION
2003 EDITION
(SUBJECT TO OWNERS APPROVAL)
________________________________________
DATE
NUMBER
PREPARED BY:
_________________________________________________________________________________________________________________________
NAME OF APPLICANT
HOME PHONE
INITIAL IF OVER 18 YEARS OF AGE
_________________________________________________________________________________________________________________________
PRESENT ADDRESS
DATES OF CURRENT OCCUPANCY:
FROM
TO
_________________________________________________________________________________________________________________________
CITY
STATE
ZIP CODE
AUTOMOBILE: MAKE/YEAR/REG. STATE & NO.
SOCIAL SECURITY#
_________________________________________________________________________________________________________________________
PRESENT LANDLORD
COMPLETE ADDRESS
PHONE NUMBER
_________________________________________________________________________________________________________________________
FORMER LANDLORD
OCCUPANCY
COMPLETE ADDRESS
PHONE NUMBER
_________________________________________________________________________________________________________________________
CURRENT EMPLOYER
COMPLETE ADDRESS
PHONE NUMBER
_________________________________________________________________________________________________________________________
OCCUPATION/SOURCE OF INCOME
TYPE OF BUSINESS
SALARY
LENGTH OF EMPLOYMENT
_________________________________________________________________________________________________________________________
FORMER EMPLOYER
LENGTH OF EMPLOYMENT
COMPLETE ADDRESS
PHONE NUMBER
_________________________________________________________________________________________________________________________
PERSONAL REFERENCE (NAME)
COMPLETE ADDRESS
PHONE NUMBER
_________________________________________________________________________________________________________________________
IN CASE OF EMERGENCY NOTIFY (NAME) COMPLETE ADDRESS
PHONE NUMBER
_________________________________________________________________________________________________________________________
CREDIT REFERENCE
COMPLETE ADDRESS
PHONE NUMBER
_________________________________________________________________________________________________________________________
BANK – CHECKING ACCOUNT
BRANCH ADDRESS
ACCOUNT NUMBER
_________________________________________________________________________________________________________________________
BANK – SAVINGS ACCOUNT
BRANCH ADDRESS
ACCOUNT NUMBER
_________________________________________________________________________________________________________________________
NAME OF ALL CO-TENANTS (EACH ADULT MUST FILE A SEPARATE APPLICATION)
_______________________________________________________________________________
APARTMENT NO./TYPE TOTAL NO. OF OCCUPANTS
NO. OF ADULTS NO. OF PETS
_______________________________________________________________________________
ADDRESS
NAMES & AGES OF MINOR CHILDREN
______________________________________________________________________________
CITY
OCCUPANCY DATE
RENT BEGINS
_______________________________________________________________________________
TERM OF LEASE (MONTHS)
FROM (DATE)
TO (DATE)
ARE YOU A CONVICTED FELON? (Y/N) ______ if “Yes” Please submit detail of conviction(s).
Base rent per month $______________________
(Subject to escalation as set forth in lease)
Other Monthly Charges_____________________
(e.g. parking, etc.)
________________________________________
Key/Lock_________________________________
Last Month’s Rent_________________________
Security Deposit __________________________
Deposit on Account ________________________
Balance Due
Upon Acceptance__________________________
Base rent and other monthly charges are due and payable on the first day of each month in advance.
Pursuant to Massachusetts law, the Management shall not make any inquiry concerning race, religious creed, color, national origin, sex, sexual
orientation, age, (except if a minor), ancestry or marital status of the Applicant or concerning the fact that the Applicant is a veteran or a member of the
armed forces or is handicapped. The Applicant authorizes the Management and/or Renting Agency to obtain or cause to be prepared a consumer credit
report relating to the Applicant.
Neither the Owner nor the Management is responsible for the loss of personal belongings caused by fire, theft, smoke, water or otherwise, unless
caused by their negligence.
The undersigned warrants and represents that all statements herein are true and agrees to execute upon presentation a Rental Housing Association