Douglas Elliman Rental Application Form - Project Binders Real Estate

NOTICE: All adult applicants (18 years or older) must complete a separate application for rental.

Apartment

Rent

Security Deposit

Agent

Start Date

Lease Length

Broker

Broker Phone

APPLICANT INFORMATION - Name *

First

Last

SSN# *

Date of Birth *

Home Phone

Work Phone *

Cell Phone *

Email *

CURRENT ADDRESS *

Please enter street, city state and zip code

Landlord / Managing Agent Name *

Monthly Rent *

Date In *

Date Out *

Landlord Phone *

PREVIOUS ADDRESS (if less that 2 years at current) *

Please enter street, city, state and zip code

Landlord / Managing Agent Name *

Monthly Rent *

Date In *

Date Out *

BANK INFORMATION - Checking Account Bank Name *

Checking Account Bank Name

BANK INFORMATION - Checking Account Number *

Checking Account Number

BANK INFORMATION - Phone Number *

Phone Number

BANK INFORMATION - Approximate Balance *

Approximate Balance

BANK INFORMATION - Savings Account Bank Name *

Savings Account Bank Name

BANK INFORMATION - Savings Account Number *

Savings Account Number

BANK INFORMATION - Phone Number *

Phone Number

BANK INFORMATION - Approximate Balance *

Approximate Balance

BANK INFORMATION - Other Account Bank Name

Other Account Bank Name

BANK INFORMATION - Other Account Number

Other Account Number

BANK INFORMATION - Phone Number

Phone Number

BANK INFORMATION - Approximate Balance

Approximate Balance

ADDITIONAL FINANCIAL INFORMATION (i.e Stocks, Bonds, Securities)

Financial Institution Name

ADDITIONAL FINANCIAL INFORMATION - Account Number

Account Number

ADDITIONAL FINANCIAL INFORMATION - Phone Number

Phone Number

ADDITIONAL FINANCIAL INFORMATION - Approximate Balance

Approximate Balance

ADDITIONAL FINANCIAL INFORMATION 2 (i.e Stocks, Bonds, Securities)

Financial Institution Name

ADDITIONAL FINANCIAL INFORMATION 2 - Account Number

Account Number

ADDITIONAL FINANCIAL INFORMATION 2 - Phone Number

Phone Number

ADDITIONAL FINANCIAL INFORMATION 2 - Approximate Balance

Approximate Balance

INCOME INFORMATION (including, but not limited to, child support, alimony, foster care subsidies, income derived from social security, or any form of federal, state, or local public assistance including, but not limited to Section 8 vouchers, or any other form of housing assistance payment or credit)

(including, but not limited to, child support, alimony, foster care subsidies, income derived from social security, or any form of federal, state, or local public assistance including, but not limited to Section 8 vouchers, or any other form of housing assistance payment or credit)

EMERGENCY CONTACT

EMERGENCY CONTACT - Address

EMERGENCY CONTACT - Phone

EMERGENCY CONTACT - Relationship

Pets?

Reasonable Accommodation Request for Service / Emotional Support Animal?

Type

Weight

Age

Describe

NOTICE ABOUT TENANT SCREENING REPORTS Tenant screening reports from consumer reporting agencies are sometimes used to assist landlords in making rental decisions. In regard to such reports, we may use such reports* by contacting the following: 1. On-Site.com, P.O. Box 1504, Los Altos, CA 94023 | Phone: (877) 222-0384 | www.on-site.com
(On-Site is a nationwide specialty consumer reporting agency) 2. Experian, P.O. Box 9554, Allen, TX 75013 | Phone: (877) 222-0384 | www.experian.com 3. Equifax, P.O. Box 740256, Atlanta, GA 30374 | Phone: (877) 575-5734 | www.equifax.com 4. TransUnion, P.O. Box 6790, Fullerton, CA 92834 | Phone (800) 680-7289 | www.transunion.com
The law requires us to notify you if we do not lease or rent to you based on information in that report. You also have the right to dispute the accuracy of the information in the report directly with the reporting agency and to obtain a free report from such agency if we do not lease or rent to you based on such report. You also are entitled to receive one free report every 12 months from any nationwide specialty consumer reporting agency used by us, as well as a free credit report every 12 months from each of the nationwide consumer credit reporting companies: Equifax, Experian and TransUnion. You can request this free credit report through the website www.annualcreditreport.com. You may dispute the accuracy of any information about you that is contained in such report directly with the credit reporting agency. You hereby authorize Douglas Elliman to disclose to the landlord and/or its agents any information provided by you and any report or search obtained based on your information.

Note: * except if paid by subsidy or qualified guarantor; if paid by subsidy, indicate & upon receipt of subsidy information, provide such information; if guarantor, indicate & answer as guarantor.

I warrant that all the statements above are true and that any false statements may be grounds for rejection of this application. I further represent that I am not renting a room or an apartment under any other name. I hereby give my permission to conduct an investigative consumer report on me. I further authorize Owner, its agent(s), and/or Douglas Elliman to conduct their credit inquiries. No representations or agreements by any third party are binding on Owner / Agent / Douglas Elliman, unless included in an executed lease. Owner / Agent / Douglas Elliman makes no guarantee regarding the status of this application or the availability of any apartment. I also confirm that I have read and understand the Tenant Screening Report Disclosure printed above. If a lease is approved and executed, this completed application form becomes part of that certain lease.

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