113 East 12th St.

New York, NY 10003

Tel. (212) 693-0200 Fax (212) 693-0800

APPLICATION FOR LEASE

**Please

PRINT Clearly ** - we do not accept scribbled applications

Date_________ Apt address_____________________________________________Rent $________________

DSA Agent: _______________________________________________
Lease to Commence _______________________________________ Number of Years: ___________

Name: ___________________________________________________ Date of Birth: ______________________________

S.S.N.: __________________ Email address:_____________________________________________________________
Current Address:___________________________________________________ Best Phone #:______________________
City:________________________________________Sate:_______________________ Zip: _______________________
Rent Paid: $_________________ Length of Tenancy:_______ years
!
!

Other tenants to occupy the apartment:

Name ! !
!
Date of Birth!

Pets?_______ Describe:__________________

S.S.N.! !

Relation to above:

1)__________________________________________________________________________________________________
2)__________________________________________________________________________________________________
3)__________________________________________________________________________________________________
Landlords Name & Address:___________________________________________________Tele.#_____________________
Previous address:_____________________________________________________________________________________
(if less than 2 years at current address)
Previous landlords address:___________________________________________________ Tele.#_____________________
Occupation:_________________________Salary $________________ Companys Name:___________________________
Companies address_________________________________________ Companys Phone # _________________________
Additional Sources of Income: ___________________________________________________________________________

I understand that no application or lease is valid or binding upon the landlord or his his agent unless its 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.
I warrant that all statements made on this applications are true and that I am not presently being or have been evicted from any apartment

In connection with my application for this apartment I authorize all banks, corporations, companies, credit agencies, accountants, persons and employers
to release any information that they have about me to the verification company, broker, owners, or any of the their agencies, and I release them from any
and all liability or responsibility from doing so. Further, I authorize the procurement of an investigative consumer report and understand that such a report
may contain information about my background, character and personal reputation. I understand this will also apply to future update reports that may be
requested.

SIGNATURE_________________________________________ DATE:______________________