RENTAL APPLICATION - PLEASE PRINT CLEARLY !

PERSONAL INFORMATION

Applicant Name ____________________________________________________________________________ 

Current FULL Address *______________________________________________________________________ 

_________________________________________________________________________________________ 
(* If less than 2 years include previous residence address(es) on reverse of this form.)

Cell Phone # _________________________________________________________________  

SS # _________________________ Email ______________________________________________________ 

EMPLOYMENT INFORMATION

Employer Name ___________________________________________  Job Title ________________________ 

Address __________________________________________________________________________________

Work Phone______________________  Gross Salary $____________ (Circle One: Weekly - Monthly - Yearly)

If Applicant has any other form of income include it on the reverse of this form. * If less than 2 years include information on reverse of this form.

BANKING & CREDIT REFERENCES

Checking A/C# _______________________________________ Bank Name ___________________________  

Debit/Credit Card A/C# ________________________________  Bank Name ___________________________  

The undersigned makes application to rent Houseshare in 36Ellis Pl., #____ Apt., Ossining, NY, Front / Rear  Private Room, w/use of Common Areas (NOT for storage) beginning  ____________. Gross monthly rent is $______.  If rent is paid on or before the first of the month Tenant gets a $30 discount so NET monthly rent will be $_______.  Rent does not include gas or electric for which Tenant is responsible for monthly payments. Security required is 1-1/2 month’s rent or $______, plus $50 that is a non-refundable cleaning/ laundering fee for Private Room.   

By signing below (and on the reverse of this form) Applicant certifies the above information provided on this form is true and accurate. This Application is subject to acceptance or rejection at Owner's sole discretion and may be rejected, or tenancy canceled, if any information is found to be inaccurate or false. Applicant understands a consumer credit report may be requested for purposes of checking or updating info, and authorizes verification of information herein, now or at anytime hereafter. 

Applicant's Signature __________________________________________________ Date _______________
Two forms of identification MUST be submitted with Application, especially a Driver License.			        2022-01

RENTAL APPLICATION - PLEASE PRINT CLEARLY !
Page 2

REFERENCES (Nearest Living FRIEND)

Name ________________________________________ City/State ___________________________________    

Phone ___________________________________ Email ___________________________________________

EMERGENCY CONTACT (Nearest Living RELATIVE)

Name/Relationship ______________________________________________  City/State __________________  

Phone ___________________________________ Email ___________________________________________

MOTOR VEHICLE   

Driver License # /State _______________________________________ Plate # /State ___________________ 

Make __________________ Model ______________________ Color __________________ Year __________ 
Ossining Law states you must have an “Overnight Parking Permit” if you own or operate motor vehicle and need to park on PUBLIC roads between 3:00AM and 6:00AM. Application, documents, and $75 must be submitted to municipality for a 1-year parking permit.

By signing below Applicant certifies the information provided on this form is true and accurate. This Application is subject to acceptance or rejection at Owner's sole discretion and may be rejected, or tenancy canceled, if any information is found to be inaccurate or false. Applicant understands a consumer credit report may be requested for purposes of checking or updating info, and authorizes verification of information herein, now or at anytime hereafter. 

Applicant's Signature __________________________________________________ Date _______________
Two forms of identification MUST be submitted with Application, especially a Driver License.			        2022-01

Additional Information