SAMPLE
APPLICATION FOR RESIDENTIAL LEASE

Section 1

First Name ________________________ Middle Initial _____ Last ______________________
Current Address _______________________ City ____________ State _____ Zip __________
Phone (H) ___________________ Phone (W) __________________ Phone (C)____________
Previous Address _________________________________________Email:________________
Soc. Sec. # _________________ Date of birth ______________ (Both needed for credit check)
Reference (non-relative) ______________________ Phone _____________________________
Name of Bank _____________________________ Location ___________________________
Guarantor: Name:___________________________Phone:____________Fax:____________

Section 2

Current Landlord (or write "Owner") _______________________ Phone __________________
Address ______________________ City ___________________ State ______ Zip _________
Rent Paid _____________________ Dates of tenancy _________________________________
Were you on the lease?  YES  NO  (circle one) If no, please explain:

If less than two years at current address:
Previous Landlord ____________________________________ Phone ___________________
Rent Paid ____________________ Dates of tenancy __________________________________
Were you on the lease?  YES  NO  (circle one) If no, please explain:

Section 3

Occupation ____________________ Salary (yr.) ____________ Employment Length _________
Company Name __________________________ Department Head ______________________
Address _____________________ City __________________ State _______ Zip __________
Phone _____________________ Fax _________________________
Additional Sources of Income:

Section 4

Emergency Contact: Name ______________________________ Relationship _______________
Address ____________________ City ___________________ State ________ Zip _________
Phone (Day) _______________________ (Evening) _______________________

Section 5

Occupants of Apartment (Co-tenants and Roommates)
1) Name ______________________________________________ Birthdate ______________
2) Name ______________________________________________ Birthdate ______________

Application Terms and Conditions

If an agreement is reached to lease any space shown by agents of Tower Brokerage, Inc., I hereby agree to pay Tower Brokerage, Inc. a commission of 15% of first years rent (unless otherwise specified on deposit receipt).
I understand that no application or lease is valid or binding on the landlord or his agent unless it is countersigned by the landlord or his agent.
I also recognize that the signing of a lease shows conclusive evidence of acceptance of this property and all deposits are binding and non-refundable unless landlord rejects this application.
I warrant that all statements on this application are true and that I am not presently being, or have been evicted from any apartment.
I acknowledge that Tower Brokerage, Inc. may conduct a credit check with respect to any and all of the above information, and I hereby consent to such credit check and agree to pay a non-refundable fee of $50 for same.

Signature _____________________________________________ Date _________________

OFFICE USE ONLY