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Date of Application *  

Referred By*
Agent*
 
   
# of Rooms    
   
Apartment No.*
 

Floor *
 
Monthly Rent $ *
 

The undersigned hereby makes application for rental of apartment and submits the following information:

PERSONAL INFORMATION

Applicant's Full Name

*
Date of Birth
 *
Social Security No.
  *
Email Address
*
Driver's License No. & State
  *
Number of Occupants
  *
# of Children
  *
Ages
  *
# male
  *
# female
  *
Occupant Names Relationship Date of Birth
     
     
     
     
     

Present Information Previous Information
Present Address
City
State
Zip
Phone #
Landlord/Mortgage Co.
Address
City
State
Zip
Phone #
Length of Residency
Current Rent
Reason for Leaving
Previous Address
City
State
Zip
Phone #
Landlord/Mortgage Co.
Address
City
State
Zip
Phone #
Length of Residency
Previous Rent

Current Employment

Employer
Address
City
State
Zip
Phone #
Employee Number
Supervisor
Supervisor Phone #
Position
Length of Employment
Weekly Wages
Overtime
(if applicable)
Previous Employment
(If present information is less than 2 years)

Previous Employer
Address
City
State
Zip
Phone #
Employee Number
Supervisor
Supervisor Phone #
Position
Length of Employment
Previous Weekly Wages
Overtime
(If applicable)
Reason for Leaving

Other Income (Please check all sources)
Social Security
Unemployment Benefits
Child Support
Alimony
Veterans Assistance
Bank Interest
Supplement Assistance  

Monthly Amount


Bank Name

 
Branch Office
 
Phone #
 
Savings Account #
 
Checking Account #
 
Other #
 

Credit References
(Credit Cards, Major Accounts, Bank Loans, etc.)
Name
Address
Phone #
Name
Address
Phone #

Personal References
(Credit Cards, Major Accounts, Bank Loans, etc.)

Friend Name

Address
Phone #

Friend Name

Address
Phone #
Relative Name
Address
Phone #

Automobile Information

Motor Vehicle Tag #

 
State
 
Make of Car
 
Year
 
Color
 

Emergency Contact Information

Name

 
Address
 
City
 
State
 
Zip
 

Phone #

 

Relationship

 

Leasing Information

Lease to Date From

To

Prorated Date

 


Pets

Do you have any pets?

No
Type
Age

 

At signing of lease, applicant will pay balance of month's rent and security deposit equivalent to one month's rent.

I hereby authorize Bucks Meadow the right to process this application for the purpose of leasing an apartment. In compliance with the Fair Credit Reporting Act, the processing of this application includes but is not limited to verifying the accuracy of information contained herein, procuring consumer reports from the consumer reporting agencies and obtaining credit information from other credit reporting companies.

It is understood that the applicant shall pay a non-refundable fee of $25.00 for the processing of the application. This fee is non-refundable whether the application is approved or rejected by Bucks Meadow or applicant cancels the application.




*Required

Co-Applicants must file separate applications.

All units are shown and made available without respect to race, color, sex, religion, national origin, familial status or handicap.