MRG

Application Form

Company Name: Makowsky Ringel Greenberg LLC
Application To Rent: TOWN SQUARE BLDG B RESIDENTIAL

Fields marked (*) are required.

Applicant Information

*First Name:

*Last Name:

Middle Name:

*Date Of Birth:

*Social Security Number:

Marital Status:

Driver's License Number:

State Driver's License Issued In:

*Phone Number:

*Email Address:

Spouse Information

Spouse First Name:

Spouse Last Name:

Middle Name:

Date Of Birth:

Social Security Number:

Other Occupants:

Driver's License Number:

State Driver's License Issued:

Phone Number:

Email Address:

All Dependents

Name

Date of Birth

Name

Date of Birth

Name

Date of Birth

How did you hear about us?

Referred By:

Reason For Leasing Here:

Emergency Contact

Please provide contact information for at least one person who does not live with you and whome we could contact in an emergency, if we are unable to contact you.

Name:

Daytime Phone:

Evening Phone:

Cell Phone:

Name:

Daytime Phone:

Evening Phone:

Cell Phone:

Character References

Name:

Phone:

Address:

Name:

Phone:

Address:

Present Address Information

*Present Address:

*Present City:

*Present State:

*Present Zip

Present Landlord/Owner Name:

Present Landlord/Owner Address:

Present Landlord/Owner Phone #:

*How Long At This Address?:

Present Monthly Rent:

Present Reason for Moving:

Previous Address

Previous Address:

Previous City:

Previous State:

Previous Zip

Previous Landlord/Owner Name:

Previous Landlord/Owner Address:

Previous Landlord/Owner Phone #:

How Long At This Address?:

Previous Monthly Rent:

Previous Reason for Moving:

Pets

*Do You Have Any Pets? Yes No

If So, How Many?:

Type:

Breed:

Color(s):

Type:

Breed:

Color(s):

Present Employer

Employer/Company Name:

Position/Title:

Address:

City:

State:

Zip:

Phone:

Supervisor Name:

Gross Monthly Salary:

Start Date:

Prior Employer

Employer/Company Name:

Position/Title:

Address:

City:

State:

Zip:

Business Phone 1:

Business Phone 2:

Supervisor Name:

Gross Monthly Salary:

Start Date:

End Date:

Additional Income

*Do you have additional income? Yes No

Monthly Amount:

Source:

Spouse Present Employer

Employer/Company Name:

Position/Title:

Address:

City:

State:

Zip:

Phone:

Supervisor Name:

Gross Monthly Salary:

Start Date:

Spouse Prior Employer

Employer/Company Name:

Position/Title:

Address:

City:

State:

Zip:

Business Phone 1:

Business Phone 2:

Supervisor Name:

Gross Monthly Salary:

Start Date:

End Date:

Spouse Additional Income

*Does your spouse have any additional income? Yes No

Monthly Amount:

Source:

Applicant represents that all of the above statements are true and complete and hereby authorizes verification of such information. Applicant is aware that lessor shall rely on such information, which may or may not be verified, in making the decision to approve this application. Information given above that is determined to be false, either before or after approval of this application, shall be grounds for owner's disapproval of this application, forfeiture of any application deposit(s) by applicant, and/or termination of right of occupancy; further, it may constitute a serious criminal offense under the laws of this state.

Key Release

The resident gives management permission to release a key to the following person(s) upon request:

Name:

Relationship:

Name:

Relationship:

If necessary, the resident will provide the individual receiving a key their entry code. The resident understands that it is his/her responsibility to notify the management office in writing should this person(s) no longer have permission to obtain a key to their apartment. By signing this release, the resident(s) agrees to hold harmless from all responsibility both the Owner and Management Agent.

Vehicles

Vehicle 1:

Year:

Make:

Model:

Color:

Tag Number:

State Issued:

Registered To:

Vehicle 2:

Year:

Make:

Model:

Color:

Tag Number:

State Issued:

Registered To:

Describe and give tage numbers of any motorcycle, van, etc., you may own:

Banking/Creditor Information

Checking Account Number:

Bank Name & Branch:

Name(s) Account is in:

Checking Account Number:

Bank Name & Branch:

Name(s) Account is in:

Savings Account Number:

Bank Name & Branch:

Name(s) Account is in:

Savings Account Number:

Bank Name & Branch:

Name(s) Account is in:

Questions

*Is any occupant a registered sex offender?

Yes No

If yes, please explain:

*Have you ever been convicted of a felony?

Yes No

If yes, please explain:

*Have you ever had any previous credit issues?

Yes No

*Have you ever had a lawsuit as a result of a previous credit issue?

Yes No

If yes, please explain:

*Have you ever filed for bankruptcy?

Yes No

If yes, when:

If yes, where:

If yes, please give the associated Bankruptcy Number:

*Have you ever been evicted?

Yes No

If yes, when:

If yes, where:

If yes, why:

1. Application fee (not refundable). Applicant must deliver to Lessor an "Application Fee" which defrays the cost of the credit report, necessary to verify Applicant's credit, and a criminal background check.

2. Administrative fee (not refundable). Applicant must deliver to Lessor an "Administrative Fee" which partially defrays the cost of the administrative paperwork.

3. Reservation Deposit. Applicant has deposited a "Reservation Deposit" in the amount stated above. In return, Lessor agrees to reserve an apartment unit of the above described type while Owner considers approval of Applicant and Co-Applicants. Co-Applicants are other persons who are listed as "Residents" above or in the attached Lease Agreement. Upon acceptance of the Rental Application by the Owner or Agent, the Reservation Deposit will no longer be refundable.

4. Withdrawal / Disapproval of Application. The Application Fee, the Administrative Fee, and the Reservation Deposit may not be withdrawn by Applicant or any Co-Applicant. If Applicant or any Co-Applicant withdraws his/her application or notifies Lessor that he/she has changed his/her mind about taking the unit after Lessor has approved the application for rental, the Reservation Deposit of all applicants will be retained by Lessor as liquidated damages. Applicant and all Co-Applicants must sign the Lease Agreement within three (3) days after receiving notice of Lessor's approval; failure to do so will result in Owner retaining Reservation Deposit as liquidated damages. The Reservation Deposit will be refunded only if Owner disapproves Applicant or any Co-Applicant.

5. Security Deposit. Once the Resident takes legal possession of the premises, the monies held initially for the Reservation Deposit will be transferred and held for the related Security Deposit.

6. Payment. Makowsky Ringel Greenberg, LLC, accepts checks and money orders for processing fees. MasterCard®, Visa®, Discover®, and American Express® are accepted through PayLease®. Transaction fees will apply. Ask your Agent for additional information regarding this service.

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