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451 Fulton Ave Hempstead NY 11550
Ph 516 292 6071 - Fax 516 292 6073

  

 
 
   





 
pen
 
 
 
 
Please note that all applicants will be charged a $50 processing fee.
 
Desired Apartment
Size:
*Rent:
Date Wanted:
 
Personal Information
*First Name:
*M. Initial:
*Last Name:
*Current Address:
*Date of Birth:
*Driver's License #:
 
Contact Information
*Home Phone:
*Work Phone:
Mobile Phone:
*E-Mail:
 
Moving Information
Please tell us a bit about where you're living at the moment and why you're looking to move:
Reason for Moving
Rent/Mtg Per Month:       $
Landlord/Mtg Name:
Landlord Address:
Landlord Phone:
 
Previous Addresses
List up to 2 of your most recent addresses. Include street addresses and zip codes.
Previous Address 1:
Dates:
Rent/Mtg per Month:       $
Previous Address 2:
Dates:
Rent/Mtg per Month:       $
 
Employment & Income Information
Tell us a bit about your current, recent and previous employment information.
Employer:
Dates of Employment: From:  
  To:     
Employer's Address:
Employer's Telephone:
Your Position:
Supervisor's Name:
Gross Wages:                $    Weekly Bi-weekly
Other Income:
Previous Employer:
Previous Employer Address:
Previous Employer Phone:
 
Roommates, etc.
Please identify the people with whom you intend to be sharing the apartment.
 
Name
(Last,First)		 Relationship D.O.B. Weekly Income
 
Miscellaneous Questions
Please answer each of these questions. You are required to answer each of these questions.
 
Do you own a dog? No Yes
Do you own a cat? No Yes
Do you own a washing machine? No Yes
Do you own an air conditioner? No Yes
Do you own a car? No Yes
Have you ever filed bankruptcy, had any judgments, or delinquent accounts? Have you ever been evicted or convicted of a crime? No Yes
 
If so, explain:
 
 
451 Fulton Ave Hempstead NY 11550
Ph 516 292 6071 - Fax 516 292 6073
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