RENTAL APPLICATION

RENTAL APPLICATION

OCEAN STATE REALTY / TOWN & COUNTRY PROPERTIES
Date*

MonthDayYear
Date
BASIC INFORMATION
Apartment address interested in?
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Total MONTHLY HOUSEHOLD income *
ALL income your house makes MONTHLY, including supplement or assistance you may receive
Facebook Name *
Email
example@example.com
Vehicle Make / Model / Plate # *
*APPLICANTS 20 & UNDER* - Parent Name & Number
If 20 or below & unable to provide please provide previous rental history below - state "HAS RENTAL HISTORY" above
Do you have an ID? (*REQUIRED AT TIME OF SHOWING IF APPROVED*)*

Yes - NYS Drivers licenseYes - Out of State Drivers licenseYes - NYS Non-Drivers IDYes - Out of State Non-Drivers IDNo
Do you have a Social Security Card? (*REQUIRED AT TIME OF SHOWING IF APPROVED*)*

Yes - OriginalYes - CopyNo - But can obtain copy / New cardNo
If No to ID or SS card: Please Explain

WHAT ARE YOU LOOKING FOR

DATE, ADDRESS OF INTEREST, # OF BEDROOMS
Desired Date to Move In*

MonthDayYear
Date you want/need to move into location
How many bedrooms are you looking for?*
Address of Interest
If interested in multiple locations, SUBMIT ONLY ONE APPLICATION - List multiple addresses here **Leave blank if open to different locations**

Additional Occupants - 18+

Additional Occupants - CHILDREN (Below 18)

RENTAL HISTORY
Current Address*

Street Address

Apartment #

CityState

Zip Code
Dates Lived at Current Address*
Landlord Name & Number*
If living with family - List "FAMILY" If owned - List "SELF"
Reason for Leaving*
Previous Address

Street Address

Apartment #

CityState

Zip Code
Dates Lived at Previous Address
Previous Landlord Name & Number
Previous Rental Reason for Leaving

APPLICANT EMPLOYMENT
Place of Current Employment*
Address of Current Employment*
Manager / Supervisor Name*
Manager / Supervisor Number*
Please enter a valid phone number.
Dates Employed *
Title or Position*
MONTHLY TOTAL INCOME - APPLICANT *ONLY**
Can you provide 2 most recent paystubs - APPLICANT *ONLY**

Yes - In printYes - OnlineNo - Please Explain
If unable to provide paystubs, please explain - APPLICANT *ONLY*
OTHER OCCUPANT EMPLOYMENT INFORMATION
Place of current employment - OTHER OCCUPANT
Address of current employment - OTHER OCCUPANT
Manager / Supervisor Name - OTHER OCCUPANT
Manager / Supervisor Number - OTHER OCCUPANT
Please enter a valid phone number.
Dates Employed - OTHER OCCUPANT
Title or Position - OTHER OCCUPANT
MONTHLY TOTAL INCOME - OTHER OCCUPANT *ONLY*
Can you provide 2 most recent paystubs - OTHER OCCUPANT *ONLY*

Yes - In printYes - OnlineNo - Please Explain
If unable to provide paystubs, please explain - OTHER OCCUPANT *ONLY*
Other Occupants employment information

ASSISTANCE / SUPPLIMENT TO INCOME

DSS, SSI, OTHER
Do you receive rental or income assistance?*

YesNo
If yes, please list what TYPE of assistance?
If yes, total amount received monthly?
Case Worker Name & Number
If you work with a facility rather than a Case Worker, list the facility or company you work with

REFERENCES
Personal Reference NAME & NUMBER *
Family, Friends, Coworkers, etc
Work Reference NAME & NUMBER
Can be same as manager / supervisor listed previously
Other References

SUBMISSION
Please verify that you are human*
I, First Name* Last Name* certify that the information provided is true and correct and that my rental application / lease agreement may be terminated if I have provided false or incomplete statements in this application.

I authorize verification of the information provided in this application, including but not limited to: background check, current and previous landlords, current employers and references.
I give my consent for the information I provided to be verified. In signing this form I am enabling OCEAN STATE REALTY/TOWN AND COUNTRY PROPERTIES LLC to confirm my employment & salary, references, rental history, as well as preform a thorough background check which includes criminal records, eviction search and a OFAC report. This signature is equally as valid as a handwritten signature and I understand that. *

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BASIC INFORMATION