Binghamton4Rent.com
Rental Application
Tenant Information
Applicant...
Please note that there will be a non-refundable $20 application fee in order to process this application.
Last Name: First Name: M.I.:
Soc.Sec #:  -  -  License #: State:
Home Phone: Cell Phone: DOB:  Pick a date
Any other names used in the past?

Co-Applicant...  
Last Name: First Name: M.I.:
Soc.Sec #:  -  -  License #: State:
Home Phone: Cell Phone: DOB:  Pick a date
Any other names used in the past?

Other Proposed Occupants...
Name
Social Security #
DOB Relationship to Applicant(s)
 -  - 
 Pick a date
 -  - 
 Pick a date
 -  - 
 Pick a date
 -  - 
 Pick a date
 -  - 
 Pick a date
Rental / Residence History
Current Residence...
Street Address:
City:
State:
Zip:
Landlord Name: Phone: Rent: Paid:
What is your reason for leaving this residence?
Is your rent currently paid in full?
 Yes     No, Explain:
Did or will you give notice?
 Yes     No, Explain:
Were you asked to leave?
 No,     Yes Explain:
Name in which utilities are billed?   
When did you move into this residence?    Pick a date

Previous Residence...
Street Address:
City:
State:
Zip:
Landlord Name: Phone: Rent: Paid:
What is your reason for leaving this residence?
Was your rent paid in full?
 Yes     No, Explain:
Did you give notice?
 Yes     No, Explain:
Were you asked to leave?
 No,     Yes Explain:
Name in which utilities were billed?   
When did you live in this residence?   From:   Pick a date  to  Pick a date
Employment Status
Current Employer...
Employment Status :
Full Time    Part Time    Student    Retired    Unemployed    Other
Employer Name:
Employer Address:
Supervisor Name:
Supervisor Title:   
Supervisor Phone:
Date Employed:   
 Pick a date to Present
Monthly Net Income: $ Other Monthly Net Income: $

Previous Employer...
Employer Name:
Employer Address:
Supervisor Name:
Supervisor Title:   
Supervisor Phone:
Date Employed:   
 Pick a date to  Pick a date

Students...
Status:
Freshmen    Sophomore    Junior    Senior    Graduate    Doctoral
Parent/Guard. Names
Address:
Employer(s):
Occupation(s):
Parent/Guard. Phone: Parental Contribution: $
Email: Other Income: $
Will Parents/Guardians Co-Sign on the Lease? Yes   No
Bank and Credit Informtion
Bank Name / Branch: Account #:   Checking    Savings
Bank Name / Branch: Account #:   Checking    Savings
Credit / Debit Cards:
Visa    MasterCard    Discover    Amex    PayPal    Other 
In Case of Emergency Notify
Name: Relationship:
Phone: Email:
Have you ever... Notice
been sued for non-payment of rent? Yes   No
been evicted from an apartment? Yes   No
declared bankruptcy? Yes   No
been sued for damages to a rental property? Yes   No
been convicted of any felony or drug-related misdemeanor? Yes   No
Binghamton4Rent.com (or any Property Owner represented by Binghamton4Rent.com) will not house any tenant who is selling or using illicit drugs or similarly allowing others to sell or use any illicit drugs or any other such unlawful acts or illegal commerce. Tenant(s) will have three (3) days to vacate premises if Tenant(s) or their guests condone such activity.
Declaration

I, DECLARE that the foregoing information is true and correct and authorize its verification through a Background Check and the obtaining of a Consumer Credit Report.

I AGREE that Binghamton4Rent.com may terminate any agreement entered to on reliance of any false statement or misrepresentation made above.

I AGREE that any information reported to Binghamton4Rent.com substantiated to be false will result in automatic forfeiture of any deposit.

I AGREE that should my application be approved by Binghamton4Rent.com, and I decide not to take the rental unit, any deposit or binder made to secure or reserve the rental unit in my name will be forfeited to Binghamton4Rent.com for the inconvenience and delay associated with re-marketing it.

I UNDERSTAND that by entering my email address and clicking on the "Agree and Submit" button below, I am electronically signing this declaration and that it will be treated as a legal and binding declaration.

 
Email Address of Applicant (REQUIRED):