APPLICANT'S PERSONAL INFORMATION

*Applicant's Name *Social Security Number

*Date of Birth *Driver's License #

*Home Phone with Area *Work Phone with Area Code

Alternate Phone *Email Address

CO-APPLICANT'S PERSONAL INFORMATION

*Co-Applicant's Name *Social Security Number

*Date of Birth *Driver's License #

*Home Phone with Area *Work Phone with Area Code

Alternate Phone *Email Address

RESIDENCE HISTORY

*Current Street Address

*City & State *Zip

*Landlord Name or Mortgage Co *Phone with Area

*Dates Occupied From-To *Monthly Payment

*Does your payment include any utilities or services? NO     YES

If yes, describe

*Reason for seeking other residence

*Previous Street Address

*City & State *Zip

*Landlord Name or Mortgage Co *Phone with Area

*Dates Occupied From-To *Monthly Payment

*Did your payment include any utilities or services? NO     YES

If yes, describe

*Reason for seeking other residence

APPLICANT'S EMPLOYMENT INFORMATION

*Current Employer *Dates From-To

*Street Address *City & State

*Zip

*Position *Supervisor

*Phone with Area

*Gross Earnings *per

*Previous Employer *Dates From-To

*Street Address *City & State

*Zip

*Position *Supervisor

*Phone with Area

*Gross Earnings *per

*Additional Income - Explain If no additional income, please put NONE.

CO-APPLIANT'S EMPLOYMENT INFORMATION

*Current Employer *Dates From-To

*Street Address *City & State

*Zip

*Position *Supervisor

*Phone with Area

*Gross Earnings *per

*Previous Employer *Dates From-To

*Street Address *City & State

*Zip

*Position *Supervisor

*Phone with Area

*Gross Earnings *per

*Additional Income - Explain If no additional income, please put NONE.

CREDIT INFORMATION

ALL FIELDS ARE REQUIRED, SO PLEASE PUT 'NONE' WHERE NEEDED!

*Monthly Loan Payment for CAR *Date From-To
                      

*Monthly Loan Payment for HOUSE *Date From-To
                

*Monthly Loan Payment for BUSINESS *Date From-To
                          

*Monthly Loan Payment for DEBT *Date From-To

I have no debts or loans

OTHER INFORMATION

*Total number of vehicles (including company/work vehicles)

Vehicle 1: *Make *Model

*Year *Color *Plate #

 

Vehicle 2: PLEASE PUT 'NONE' IN EACH FIELD IF NO SECOND VEHICLE

*Make *Model

*Year *Color *Plate #

*Other Vehicle, Motorcycle, Boat, Etc. - NO     

YES - Describe Each

HAVE YOU EVER:

*Been sued for non-payment of any credits? NO     

YES - Explain

*Been evicted or asked to move out? NO     

YES - Explain

*Declared Bankruptcy? NO     

YES - Explain

*Broken a Rental/Lease Agreement ? NO     

YES - Explain

*Been convicted of damage to property? NO     

YES - Explain

*In case of personal emergency, notify (full name) *Relationship

*Phone 1 with Area *Phone 2 with Area

*Street Address *City & State

*Zip

OCCUPANTS: Note - No more than 2 adults and no more than 2 children under the age of 18 may occupy premises.

*How many people will occupy this unit total?

*Number of Adults *Number of Children

*1st Adult's Complete Name

*2nd Adult's Complete Name If none, put NONE.

*1st Child's Complete Name If none, put NONE.

*1st Child's Age If none, put O.

*2nd Child's Complete Name If none, put NONE.

*2nd Child's Age If none, put O.

*Do you have any pets? NO    

YES - How many? Name each kind

*Additional information that might help management evaluate your application
                                                                                                                                If none, put NONE.

*Which property are you most interested in?

First Ave. Duplex    300 Place     400 Place      Parkview Duplex

*How did you hear about our property?

PLEASE MARK THE FOLLOWING 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.

Dated: November 28, 2006