Cold Spring Main Street Rentals

Applicant Information

Last Name *

First Name *

Middle Name

Date of Birth *

Social Security No. *

Phone (Home)

Phone (Cell) *

Phone (Other)

Email Address *

Marital Status

# of Dependents

Ages of People Living in This Apt

Current Address

Street Address *

City *

State *

ZIP *

Monthly Rent

Years at This Address

Landlord Name & Phone

Former Address (2)

Street Address

City

State

ZIP

Monthly Rent

Years

Landlord Name & Phone

Present Employment

Employer Name *

Position / Title *

Years There

Months There

Employer Address

Employer ID / Badge #

Business Phone

Net Wages *(Wages after all taxes and deductions are taken out.)

Weekly Bi-Weekly Monthly

Former Employer (if less than 3 years at present job)

Former Employer Name

Position

Address

Years There

Background

Have you ever been evicted or involved in an eviction proceeding?

Yes No

Have you ever been convicted of a felony?

Yes No

If yes to felony — please provide details

Have you ever been bankrupt? (Omit if more than 7 years ago)

Yes No

If yes to bankruptcy — details

Are there any unsatisfied judgments against you? (Omit if more than 7 years ago)

Yes No

If yes — Amount $

If yes — To whom owed?

Personal References (2 required)

Reference 1 — Name *

Phone *

Address

Reference 2 — Name

Phone

Address

Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not residence is approved. I authorize you to obtain consumer reports and to check my employment history and previous residence information.

I certify the above is true and authorize Cold Spring Main Street to verify this information. *

Apply to Rent