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Rental Application Form
Building Address Apt #
Monthly Rent Occupancy Date
Applicant Name DOB (MM/DD/YY) SSN
Present Address Apt#
City State Zip
Monthly Rent How Long did you live there?
Previous Address
(if less than 2 years):
Phone
Mobile Phone Email
Employment Information
Company Name Phone
Company Address State Zip
City Salary Bonus
Title
Additional Sources of Income
References
Landlord Phone
Address Apt#
City State Zip
Name Phone
Name Phone
Name Checking Acct#
Savings Acct # Do you have Credit Cards?
If Yes, Please list
Occupant Information
Number of Adults Children: Pets
Signature
Date


In accordance with the laws of New York City, Applicant is advised that information provided by Applicant may be used to obtain a tenant screening report (also known as a Consumer Report) from a Consumer Reporting Agency.  The name and address of the Consumer Reporting Agency is:

Sanjeonics Background Checks
11 High Street
Milton, MA 02186
Telephone: 617. 298.8943

In addition, on behalf of the Owner of the Building for which this application is being accepted (the “Owner”), we are notifying Applicant that, pursuant federal and state law:

(1) If the Owner takes an adverse action against Applicant on the basis of information contained in a tenant screening report, we must notify Applicant that such action was taken and supply the name and address of the consumer reporting agency that provided the tenant screening report on the basis of which such action was taken;

(2) Any Applicant against whom adverse action is taken based on information contained in a tenant screening report has the right to inspect and receive a free copy of such report by contacting the consumer reporting agency;

(3) Every Applicant is entitled to one free tenant screening report from each national consumer reporting agency annually in addition to a credit report that should be obtained from www.annualcreditreport.com; and

(4) Every Applicant may dispute inaccurate or incorrect information contained in a tenant screening report directly with the consumer reporting agency.

 
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