Date of Application *
E-mail Address: *
PRIMARY APPLICANT'S PERSONAL INFORMATION
Applicants Full Name *
Date of Birth *
Cell Phone Number with Area Code *
Work Phone Number with Area Code *
Alternate Phone Number with Area Code
CO-APPLICANT'S PERSONAL INFORMATION
Co-Applicants Full Name *
Date of Birth *
Cell Phone Number with Area Code *
Work Phone Number with Area Code *
Alternate Phone Number with Area Code
Email Address *
RESIDENCE HISTORY
Current Street Address *
City *
State *
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
-Terr.-
AS
FM
GU
MI
PR
VI
Zip Code *
Landlord Name or Mortgage Co. *
Landlord / Mortgage Co. Phone Number with Area Code *
Dates Occupied From - To *
Monthly Payment *
Does your payment include any utilities or services *
Yes
No
If Yes, please describe
Reason for seeking other residence *
Previous Street Address *
City *
State *
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
-Terr.-
AS
FM
GU
MI
PR
VI
Zip *
Landlord Name or Mortgage Co. *
Landlord / Mortgage Co. Phone Number with Area Code *
Dates Occupied From - To *
Monthly Payment *
Did your payment include any utilities or services *
Yes
No
If Yes, please describe
Reason for seeking other residence *
PRIMARY APPLICANT'S EMPLOYMENT INFORMATION
Applicants Current Employer *
Employment Dates From - To *
Employer Street Address *
City *
State *
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
-Terr.-
AS
FM
GU
MI
PR
VI
Zip *
Applicants Position with Employer *
Supervisors Name *
Employer Phone Number with Area Code *
Gross Earnings per *
Year
Month
Amount *
Applicants Previous Employer *
Employment Dates From - To *
Employer Street Address *
City *
State *
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
-Terr.-
AS
FM
GU
MI
PR
VI
Zip *
Applicans Position with Employer *
Supervisors Name *
Employer Phone Number with Area Code *
Gross Earnings per *
Year
Month
Amount *
Additional Income - please list *
CO-APPLICANT'S EMPLOYMENT INFORMATION
Co- Applicants Current Employer *
Employment Dates From - To *
Employer Street Address *
City *
State *
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
-Terr.-
AS
FM
GU
MI
PR
VI
Zip *
Co-Applicants Position with Employer *
Supervisors Name *
Employer Phone Number with Area Code *
Gross Earnings per *
Year
Month
Amount *
Co-Applicants Previous Employer *
Employment Dates From - To *
Employer Street Address *
City *
State *
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
-Terr.-
AS
FM
GU
MI
PR
VI
Zip *
Co-Applicants Position with Employer *
Supervisors Name *
Employer Phone Number with Area Code *
Gross Earnings per *
Year
Month
Amount *
Co-Applicants Additional Income - please list *
CREDIT INFORMATION
Do you have any debts / loans? *
If 'No', all * fields following must still have an answer. If not applicable, enter: None
Yes
No
Monthly Loan Payment for VEHICLE *
Date From - To *
Monthly Loan Payment for HOME *
Date From - To *
Monthly Loan Payment for BUSINESS
Date From - To
Total Monthly Payment for other DEBTS *
Date From - To *
OTHER INFORMATION
Total Number of Vehicles (including company/work vehicles) *
Vehicle 1 Make & Model *
Vehicle 1 Year & Color *
Vehicle 1 License Plate Number *
Vehicle 2 Make & Model *
Vehicle 2 Year & Color *
Vehicle 2 License Plate Number *
Do you have additional vehicles, motorcycle, boat, trailor, etc.? *
Yes
No
If Yes, Make, Model, Year, Color, & License Plate Number for each
Have you ever been sued for non-payment of any credits? *
Yes
No
If Yes, please explain
Have you ever been evicted or asked to move out? *
Yes
No
If Yes, please explain *
Have you ever declared Bankruptcy? *
Yes
No
If Yes, please explain *
Have you ever broken a Rental / Lease Agreement *
Yes
No
If Yes, please explain *
Have you ever been convicted of damage to property? *
Yes
No
If Yes, please explain *
In case of emergency, name of person we are to contact *
Your relationship to your emergency contact *
Emergency Contacts Primary Phone Number *
Emergency Contacts Secondary Phone Number *
Emergency Contacts Street Address *
City, State, Zip *
OCCUPANTS
How many people will occupy this unit, total *
Does anyone that would occupy the unit smoke? *
Yes
No
Do you have any pets? *
Yes
No
If Yes, how many ?
Name of each pet kind (dog, cat, hampster, fish, etc.)
Which property are you most interested in renting? *
First Avenue Duplex
300 Place
400 Place
500 Place - 2 Bedroom
500 Place - 3 Bedroom
College Park Duplexes
Parkview Duplex
Earliest date you would want occupancy?
Latest date you would want occupancy?
Additional information that might help management evaluate your application. *
How did you hear about our property? *
REQUIRED CHECK BOX AFTER READING THE FOLLOWING STATEMENT: *
By this mark and by submitting this form, I represent that I have read this entire application and that all of the above information submitted is true and correct. I further represent that my rental and credit records are in good standing with no judgments or liens against me. If any of the above information is false, I hereby agree that my entire deposit may be forfeited to BRT Property Management, LLC. I further understand that this application is not a lease and should this application be accepted, I agree to sign BRT Property Management's lease form currently in use. If for any reason whatsoever BRT Property Management, LLC is unable to make available at the beginning of the lease term the unit which is the subject of this application, I hereby waive any and all rights to seek to recover any damages whatsoever against BRT Property Management, LLC, including without limitation, actual, punitive, or consequential damages. I hereby authorize any past property managers or landlords to provide BRT Property Management, LLC with any information related to pat residence history. It is policy not to discriminate on the basis of race, creed, color, national origin, religion, age, or sex. I understand this application is void after thirty (30) days.
NO, I do not acknowledge and agree
YES, I acknowledge and agree
WE DO CREDIT CHECKS WHEN WE
FEEL IT IS NECESSARY.
Verification Code:
Enter Verification Code: *
* Required