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2003 Avenue Ji Brooklyn, NY 11210iTel: 718-377-0708iFax: 718-692-3682
APPLICATION FOR OCCUPANCY
PROPERTY ADDRESS:APT: RENT/MAINTENANCE $:
Applicant: Please print all information clearly. Include all account and phone numbers. Read, sign, and date application.
Personal Information
Name: / Date of Birth (optional): / /First Middle Last
Driver’s License #: / State: / Social Security #: - -
Residence Information
Current:Address/Apt. City State Zip
Rent/Maint $ / Move in Date: / Expiration Date: / Phone: ( )
Landlord: / Phone: ( )
Company Name Address City State Zip
Employment Information
Current:Employer Name Address City State Zip
Position: / Annual Income $ / Phone: ( )
Supervisor’s Name: / Start Date: / Phone: ( )
Previous Employer/ or 2nd Job: / Annual Income $
Position: / Start Date: / End Date: / Phone: ( )
Bank Information
Bank: / Average Balance $Name City State Zip
Account Number: / Checking Saving / Bank Phone: ( )
Bank: / Average Balance $
Name City State Zip
Account Number: / Checking Saving / Bank Phone: ( )
Other Residents to Occupy Apt.
/Social Security #
/Relationship (optional)
/Sex (optional)
/Age (optional)
Do you have any pets? Yes No Dog Cat Other :Car: / Year: / State: / Plate:
In case of emergency, contact:
Name Telephone City State Zip
This application is subject to approval by the owners or agents and may be without cause disapproved by them. This application may be made a part of your lease. I hereby authorize G & D Agency LLC to use any consumer reporting agency, credit bureau or investigative agency to confirm the information contained herein pertaining to my employment history, credit history, prior tenancies, character and to obtain a credit report and any other credit information, and to disclose such information to the owner/agent or representative in support of this application. I have completed this application and recognize that the truth of the information contained herein is essential.
APPLICANT’S SIGNATURE DATEApplication fee is Non Refundable
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