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Applicant First Name: Last Name: Date of Birth: Present Address: No. Years: Own Rent Parent Other Street: City: State: Zipcode: Home Phone: ( ) Cellular Phone: ( ) Landlord: Landlord's Phone: ( ) Reason For Leaving: Former Address (if less the 2 years): Street: City: State: Zip Code: Landlord: Landlord's Phone: ( ) SSN#: Driver License#: Employer: Contact Person: Address: Work Phone: ( ) Job Title: Gross Wkly Earnings: Previous Employer If Less then 2 yrs.: Contact Person: Address: Work Phone: ( ) Job Title: Gross Wkly Earnings:	Co-Applicant First Name: Last Name: Date of Birth: Present Address: No. Years: Own Rent Parent Other Street: City: State: Zipcode: Home Phone: ( ) Cellular Phone: ( ) Landlord: Landlord's Phone: ( ) Reason For Leaving: Former Address (if less the 2 years): Street: City: State: Zip Code: Landlord: Landlord's Phone: ( ) SSN#: Driver License#: Employer: Contact Person: Address: Work Phone: ( ) Job Title: Gross Wkly Earnings: Previous Employer If Less then 2 yrs.: Contact Person: Address: Work Phone:( ) Job Title: Gross Wkly Earnings:
Have you ever filed for bankruptcy? Yes  No Have you ever been or are you now being evicted? Yes   No Have you ever refused to pay rent when due? Yes   No Personal References Name \Street\City&State\Zip Code \ Phone Applicant: ( ) ( ) Co-Applicant: ( ) ( ) Banking References Bank Name\Bank Phone Applicant:   ( )   ( ) Co-Applicant:   ( )   ( ) Name and ages of each person to occupy apartment other than applicant and co-applicant (for ages in months please type the word month or months after the age. ex. 4 months):     NAME                      AGE 1.   2.   3.   4.   Automobile Information Make of Automobile / Year / License No:/State                 Do you have a pet? Yes   No    What Kind?     How Many: Do you smoke? Yes   No Motorcycle? -  Yes   No Watercraft? -  Yes   No Trailer? -  Yes   No Snowmobile? -  Yes   No How did you hear of NyOnlineRealty.Com AllSpaces.com Apartments.com Business Card Craigs List Direct Mail Friend Message Board - Car Wash Message Board - Gym Message Board - Laundromat Message Board - Supermarket Newsday Online NYOR.com PennySaver Rentnet.com Search Engine Town Crier Other: Emergency Contact (other than Co-Applicant) Name \Street\City&State\Zip Code \ Phone ( ) ( )