Apartment Application Form
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1APARTMENT APPLICATION
PLEASE PRINT CLEARLY
31-87 Steinway Street, #5, Astoria, NY
Tel: 718.777.8212 - Fax: 718-777-8214
Email:
APPLICANT INFORMATION
Date of Application:
Applying for Apartment #:
Desired Move In Date:
Contact Information:
First Name:
Last Name:
Date of Birth:
Social Security Number:
Cell Phone:
Work Phone:
Children under age of 10: Yes No
Enlisted in Military? Yes No
Email:
Current Rental Information:
Street Address:
City:
State/Zip:
Landlord Name:
Landlord Phone Number:
Current Rent Amount:
Reason For Leaving:
Years Lived at Address:
Current Employment Information:
Company Name:
Company Contact Number:
Position:
Annual Income: $
Length of Employment:
Additional Questions For All Applicants:
Yes No
Are you currently enlisted in the military or reserves?
(i.e.: Military, Marines, Army, Navy, etc)
If yes, please list which you are enlisted for:______________
Yes No
Have you or any roommates ever had bed bugs?
Yes No
Have you ever been evicted from an apartment?
Yes No
Have you ever declared bankruptcy?
Yes No
Do you have a criminal record?
Yes No
Are you or any other people in your apartment smokers?
Yes No
Do you have any pets? (We do NOT allow ANY pets)
How Did You Hear About Us?
APARTMENT MUST BE VIEWED BEFORE SUBMITTING THIS APPLICATION
I certify by my signature below that all the information given above is true and correct and I understand my lease or rental
agreement may be terminated if I have made any false or incomplete statement in this application.
I authorize verfication of the information provided in this application from my credit sources, credit bureaus, current and
previous landlords and empolyers, and personal references.
I understand the application fee is non refundable. I understand the lease must be signed within 48 hours of submitting my
application. I have viewed the apartment prior to submitting this application.
I understand if it is determined I worked with a broker and did not mention it on this application I will be liable to pay the
broker's commission.
Applicant's Signature
Date
OFFICE USE ONLY:
Application Approved:
Yes
No
Lease Sign Date:
Application Fee Received:
/
/2013 $_________
Move In Date:
Move In Adjustment Amount: $
Broker Name:
Move In Funds Received:
First Month Rent
Security
Prepaid Last Month Rent
Children under age of 10:
Yes
No
Quantity of Window Guards Needed:
Window Guard Fee collected: /
/2013 $_________
Lease Date:
Stabilized
Last Legal:
New Legal:
Non-Stabilized
Vacancy Increase:
Pref Credit:
last revised 5/2013
New Legal:
New Rent:
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