Hitztory Realty Rental Application

Welcome to Hitztory Realty? How did you hear about us? Who referred you? Please Specify person or agency so we can thank them!*
New York State Disclosure Form for Landlord and Tenant

This disclosure is required by New York State law to help you make informed choices about your relationship with the real estate broker and its sales agents.

Tenant’s Agent: A tenant’s agent is an agent who is engaged by a tenant to represent the tenant’s interest. The tenant’s agent does this by negotiating the rental or lease of an apartment at a rent and on terms acceptable to the tenant. A tenant’s agent has the following fiduciary duties to the tenant: reasonable care, undivided loyalty, confidentiality, full disclosure, obedience, and duty to account. A tenant’s agent does not represent the interest of the landlord.

Acknowledgment: By signing this application, the Applicant(s) confirm they have received this disclosure and understand that Daniel Bledsoe /Hitztory Realty is acting as a Tenant’s Agent in this transaction.
Acknowledgment: I (the Applicant) confirm that I have received this disclosure and understand that Hitztory Realty is acting as my Tenant’s Agent in this transaction.*

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Broker Compensation & FARE Act Disclosure

In accordance with the NYC FARE Act (2025), the party who hires a broker is responsible for the broker’s compensation.

Engagement: The Applicant hereby engages Hitztory Realty to act as their representative for the purpose of identifying and securing a rental property.

Professional Fee: The Applicant agrees to pay a brokerage fee of 15% of the annual rent for these services.

Negotiability & Discretion: The Applicant acknowledges that all brokerage fees are negotiable by law. At the sole discretion of the Broker, a reduced fee may be negotiated or accepted on a case-by-case basis. Any such reduction must be confirmed in writing by Hitztory Realty to be valid.

Exemption: If the Applicant rents a property where the Landlord has hired the broker and agreed to pay the brokerage fee, the Applicant shall owe no fee to Hitztory Realty.

Payment Term: The fee is earned upon a "meeting of the minds" (lease execution) and is payable in full at or before lease signing.

Protection Period: This agreement applies to any property introduced by Hitztory Realty for a period of 120 days following the date of this application.
"I, the Applicant, have read and understood the Brokerage Fee Agreement. I explicitly agree to the fee structure, the terms of my engagement of Hitztory Realty as my Tenant’s Agent, and the $20 application fee cap as disclosed. I understand that my electronic signature below is legally binding as per NYS Electronic Signatures and Records Act (ESRA)."*

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Notice of Fair Chance for Housing Act

Fair Housing & Income Disclosure: Hitztory Realty complies with all Federal, State, and NYC Fair Housing laws. We accept all lawful sources of income, including housing vouchers and subsidies.

Application Fee Cap: In accordance with New York State Law, the fee for a background and credit check is capped at the actual cost of the service or $20.00, whichever is less.

Fee Waiver: This fee shall be waived if the Applicant provides a copy of a background or credit check conducted within the past 30 days.
Authorization: I hereby authorize Hitztory Realty to obtain a consumer credit report and/or background check for the $20.00 fee. I understand that I am entitled to a copy of the report and a receipt/invoice from the entity that conducted the check.*

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Upload Identity & Income Documents here.*

To verify your application and protect against identity theft, please upload the required documents below. All files are transmitted via an encrypted, secure connection and will be handled in strict accordance with NYS privacy laws.Please provide clear, legible copies of the following:Government-Issued Photo ID: (e.g., Driver’s License, Passport, or NYCID).Proof of Social Security: (Copy of SS Card, or a 1099/W2/Official document showing the number).If you are using a smartphone, you can select "Take Photo" after clicking the upload button to capture your documents directly.
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Full Name*

First NameLast Name
Current Address (Within Last 90 Days)
Social Security Number
Whats The Best Phone Number To Reach You At?
Email
example@example.com
Total number of occupants?
What area or zipcode are you trying to move to?*
How soon are you looking to move?
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reason For Moving From Above Address?*
Previous Landlord Contact

Source of Income/ Subsidies*
What is your total monthly or annual income?
Income Verification Documents (Finance)

Please upload your paystubs, bank statements, Social Security award letter, or your Housing Voucher/Subsidy approval letter.
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Final Step: Upload Your Documents

To complete your application, if you havent already please provide clear copies of the documents listed below. You may upload files directly from your device or take a photo using your smartphone.

1. Proof of Identity & Legal Status

Government-Issued Photo ID (Driver’s License, Passport, or NYCID).
Proof of Social Security Number (Card copy or official document).
2. Income & Employment Verification

If Employed: Employment Letter (on company letterhead with salary, start date, and supervisor contact) and your most recent pay stubs (4 if weekly, 2 if bi-weekly).

If Using a Subsidy/Voucher: A copy of your current Housing Voucher or Subsidy Award Letter.
Other Income: Benefit Budget Letter (SSI, Disability, Pension, Child Support, etc.).
Annual Tax Docs: W-2 or 1099 for the most recent tax year.

3. Financial & Rental History

Bank Statements: Two (2) most recent months (You may black out your account number for privacy).

Rent Verification: Most recent rent receipt, cleared check, or money order stub.

Reference Letters: One (1) Landlord reference and two (2) personal character references.
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Take Photos
Attention

Need Help?

If you encounter technical issues or prefer an alternate submission method for documents,

please contact us directly. 📞 Office: 347-871-6974

📧 Email: hitztoryrealty@gmail.com if emailing please include your FULL NAME in Subject Line!!!
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Applicant’s Certification & Declaration

I, the Applicant, hereby certify that the information provided in this application and the attached documents (including ID, paystubs, and financial statements) is true, accurate, and complete to the best of my knowledge.

Authorization: I authorize Hitztory Realty to verify any information contained herein, including contacting current/previous landlords and employers.

Penalty of Perjury: I understand that providing false or misleading information is a material breach of the application process and may result in the immediate rejection of this application or the future termination of any lease agreement.

Digital Signature: I acknowledge that my electronic signature below holds the same legal force and effect as a handwritten signature under the NYS Electronic Signatures and Records Act (ESRA).
Signature*

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