This Application Will Not Be Considered Unless Filled out Completely

Rockwood Rental Application

This application will not be considered unless filled out completely.

All Security deposits are non-refundable unless Rockwood Gardens, at it's sole description, rejects this application.

• Fill it out completely

•Sign it

•Provide a copy of a Drivers License

•Provide a copy of a Social Security Card

•Send it to us

Each applicant 18 years or older must fill out their own application.

What floor level? ________________

When needed? ______________________

# of Bedrooms ____ 1 ____ 2

Pet? ____ Type of Pet _______________

Applicant #1 (full name) ____________________________________________________

Social Security # ______________________ Date of Birth __________________

Martial Status _____________________________

Current Address ___________________________ City ________________________

State ________________ Zip _________________ Telephone # __________________

Current Landlord _____________________________ Telephone # __________________

How Long at Current Address? __________________ Rent Amount $ _____________/mo

Reason for Moving? ________________________________________________________

Previous Address _____________________________ City ________________________

State ________________ Zip _________________ How Long? __________________

Previous Landlord ____________________________ Telephone # __________________

Employer ___________________________________ Personnel Telephone # __________

Employer's Address _____________________________________________ Zip ________

Position Held ________________________________ How Long? __________________

Annual Income from Employment $ _______________ Additional Income $ ____________

Describe Source of Additional Income ___________________________________________

Phone # if Applicable __________________________

Credit References

Name/Address of Bank ____________________________________________ Zip __________

Credit Cards Held ___________________________________________________________

Make and Year of Car _________________________ License Plate # _________________

Driver's License # ____________________________ Registration # __________________

Copy of License _______________________________ Copy of Social Security Card _____________

In Case of Emergency, Contact:

Name ________________________________________ Relationship ________ Tel# ________

Address _____________________________________________________________________

City _________________________________________ State _______________ Zip _______

Emergency Contact #2:

Name ___________________________________________________ Tel # _______________

Please List All Other Persons Who Will Reside in this Apartment:

Name ________________________________ Relationship ______________ D/O/B _________

Note: Having persons living in the apartment other than those listed would be a breach of lease and may result in eviction.

This does not represent an offer to lease an apartment, but is an application only. Nothing will be binding on either party unless, and until a Lease is fully executed by both the Landlord and Tenants (s).

I hereby authorize the persons listed above to release to the Landlord any information contained in this application, in order to process this application.

I hereby warrant that all my representations set forth above are true. I further represent that I am not renting another residence under any other name, nor have I ever been dispossessed from any apartment, nor am I now being dispossessed.

* No Pets Allowed *

Other than cats within certain restrictions. See Landlord's agent for details.

Signature _____________________________________________________________ Date _________________________

Received by __________________________________________________________ Date _________________________

Rockwood Gardens Associates

51 Rockwood Circle Apt. 20A Rental Office

Middletown, NY 10941

845-692-2939

Rental Application Terms

PLEASE READ ALL OF THE TERMS ON THIS FORM CAREFULLY AND SIGN BELOW:

This application is subject to the owners and/or agents review, and may be denied by them without designating the cause except as hereinafter provided. If and when a lease is made this application will be made a part of the lease. The truth of information contained herein is essential and if the owner / or its agents deems any answer or statement herein to be false or misleading, it shall be considered that any lease granted by virtue of this application may be cancelled immediately at our option. I hereby authorize Rockwood Gardens Associates and/or Snow Asset Management, Inc. as Management Agent to use any consumer reporting agency, credit bureau, or any other investigative agencies employed by such, to investigate the references herein and other data obtained from me or from any other person pertaining to my employment history, credit, prior tenancies, and character to obtain a consumer report and such other credit information, and to disclose such information to the subscriber in support of this application and in the event that a lease is made any time during the lease. I have been advised that I have the right under Section 606B of the Fair Credit Reporting Act, to make a written request, within a reasonable time, for a copy of my credit report should my application for a Lease be denied on the basis of information contained in the credit report. I further give permission to all references listed to respond confidentially to requests for information regarding my employment history, prior tenancies, and / or character. It is understood and agreed that in the event of a lease it will be used strictly as a residence and to be occupied by no more than_________ persons.

______________________________ ________________

Signature of Applicant Date