OFFICE PROCEDURE WARRANTS THAT A PHOTOSTATIC COPY OF IDENTIFICATION
(driver’s license or passport) BE SUBMITTED WITH THIS LEASE APPLICATION
LEASE APPLICATION
PLEASE FILL IN EACH ITEM (PRINT)
BUILDING ____________________________APT.
201 W 94th St. New York, NY 10025 _______________________DATE
5B _______________________
5/20/2024
Term of Lease __________________________From:________________________To__________________________
06/01/2024 08/15/2024
Rent per month $ ________________________
1420 Security $_____________________
No. adults _________
1 No. Children __________
0 Any pets _________
No (Specify type and no.) ____________________
Applicant’s Date of Birth: 09/01/2004 Home #
Full Name Samuel Carter S.S. No. 004068148 Cell# (207) 699-8778 ______
Present
Address 238 Bruce Hill Rd. Cumberland, ME Zip Code 04021
Present Landlord’s
Name and Address Cory Carter Phone No. ( 207)
No. of Years at Reason for
Present Address 8 Moving Internship Monthly Rent $ 0
Previous
Address Zip Code
Previous Landlord’s
Name and Address Phone No. ( )
No. of Years at Reason for
Previous Address Moving Monthly Rent $ ________
Present Employer’s
Name and Address Phone No. ( )
No. of Years
Employed Positions Held Salary $
Other Current Income
(Describe Fully) Total Income $
Previous Employer’s
Name and Address Phone No. ( )
No. of Years
Employed Positions Held Salary $
Name of Checking _____ Name of Checking ____
Bank Savings Account No. Bank Savings Account No.
Address Address
Credit Cards (name only)
Personal Reference
Name Address Phone No. ( )
Business Reference (other than employer)
Name Address Phone No. ( )
In Case of
Emergency Contact Phone No. ( ) Relationship
Are you now in the Military Service or dependent of a serviceman?
This application is subject to approval of the Landlord(s) and may be disapproved without designating cause, it
being agreed that any such disapproval shall not be considered a reflection upon the applicant. This application shall
not be a part of any lease, but if the truth of the information contained herein is false or misleading, any lease granted
by virtue of this application may be cancelled at Landlord’s option. The applicant authorizes Landlord to use any
consumer reporting agency, credit bureau or other investigative agencies to investigate the references herein listed or
statements or other data obtained from the applicant or from any other person pertaining to the applicant’s history,
credit, prior tenancies, character, general reputation, personal characteristics and mode of living, to obtain a consumer
report and such other credit information which may result thereby, and to disclose and furnish such information to the
Landlord / Agent listed above in support of this application at any time. I have been advised that I have the right, under
Section 606B of the Fair Credit Reporting Act, to make a written request, within reasonable time for a complete and
accurate disclosure of the nature and scope of any investigation.
The applicant acknowledges that: (i) information provided in this application will be used to obtain a tenant
screening report; (ii) one or more of the following consumer reporting agencies may be used; Experian (TRW), Att:
NCAC, P.O. Box 949, Allen. TX 75002 (800) 682-7654; Trans Union, Consumer Disclosure Center, P.O. Box 390,
Springfield, PA 19064 (800) 888-4213; (iii) the applicants is entitled to a free copy of the tenant screening report from
each national consumer reporting agency annually, in addition to a credit report that should be obtained from
www.annualcreditreport.com; and (v) the applicant may dispute inaccurate or incorrect information contained in a
tenant screening report directly with the consumer reporting agency.
It is understood that any deposit is accepted subject to Landlord’s approval, reference and bank accounts. All
references will be thoroughly checked before commitment is made. If application is accepted, lease must be signed
within the week. Landlord will in no event be bound unless leases executed by the Landlord have been delivered to the
Tenant.
IT IS UNDERSTOOD THAT THIS FORM IS MERELY AN APPLICATION TO LEASE AND
IS NOT BINDING ON THE PART OF THE LANDLORD OR ITS AGENTS.
The acceptance of deposit does not commit the Landlord in any way.
A $25.00 non-refundable credit check fee must accompany this application.
SIGNATURE
SIGNATURE
