New York Rental Application Page 2
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1
2Current Employer
Phone
How long with this employer?
Supervisor
Phone
Current gross income per month
Previous employer
Phone
How long with this employer?
Supervisor
Phone
Other sources of income
Bank Name
Branch
City
Checking Acct#
Savings Acct#
License Number:
Vehicle: Make:
Model
Year
Vehicle plate no:
Is the vehicle registered in New York State? __Yes __No
If no, please indicate state
Personal reference:
Address
Phone
Personal reference:
Phone
Address
Phone
Emergency Contact Number:
Name
Address
Phone
I declare that the statements above are true and correct. I hereby 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. I understand that providing
false, misleading or incomplete information will result in my application being denied.
Date
Signed
Office Use Only
Date Received
Time Received
Date Verification completed
Denied __Yes __No
Reason:
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Parent category: Business