Personal Information

Please complete every cell to avoid follow ups

First Name *

Last *

Cell *

Currently Living *

Address *

Home # *

SSN

(can be remitted separately by e-mail or regular mail)

Date of Birth *

Email *

Graduation Year

Major

Parental / Guarantor Information

Father's Name

Last

SSN

Employment

Occupation

Office #(Ext)

Address

Home #

Cell

Fax

E-mail

Mother's Name

Last

SSN

Employment

Occupation

Office #(Ext)

Address

Home #

Cell

Fax

E-mail

Will Parent(s) or Guarantor(s) agree to pay the rent?

Yes

No

Property of interest (list here)

1st

2nd

3rd

4th

Period Wanted (Approximate)

Starting date:

Ending Date

Proposed Roommates (if already known)

Full Name

Cell

E-mail

Full Name

Cell

E-mail

Full Name

Cell

E-mail

Full Name

Cell

E-mail

Full Name

Cell

E-mail

Self Employed Applicants

Company Name

Salary:

Supervisor's Name

Phone #

Attachments

Copy of any picture ID is fine

Can be remitted separately by e-mail or regular mail

Clause

"Applicant affirms all above information to be true and accurate. Applicant understands that, if found false, misleading or incomplete, tenancy can be denied or terminated with loss of deposit. Landlord can contact parent(s) or guarantor(s) for payment of rent and for any other matter related to tenancy. Landlord, if requested, can release information about tenant to representative of college attended by tenant and to any local, state, or federal authorities. Tenant agrees to all above." NOTE: Please send application by e-mail and mail a signed copy with the reservation deposit of $600.00 (made payable to Dr. P. Perretta) to above address. Said deposit shall be fully refundable ‘till applicant has confirmed intent to rent a specific unit.

Signature

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