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RENTAL APPLICATION AND AGREEMENT

COOPER REAL ESTATE MANAGEMENT

55 HALSEY ST

NEWARK, NEW JERSEY 07102

OFFICE: (973) 624-3300 | FAX: (973) 624-2666

Enter Today's Date

Building Address

APT #

THERE IS A TWENTY-FIVE ($25.00) DOLLAR, NON-REFUNDABLE APPLICATION FEE REQUIRED WITH EVERY APPLICATION

NO EMPLOYEE OF THE LANDLORD IS PERMITTED TO RECEIVE ANY FEE OR COMMISSION FOR RENTING OR RESERVATION OF APARTMENTS. APPLICANT REPRESENTS THAT HE HAS MADE NO SUCH PAYMENT IN CONNECTION WITH THIS APPLICATION.

THE UNDERSIGNED APPLIES FOR THE OCCUPANCY OF THE APARTMENT AND UNDERSTANDS AND ACKNOWLEDGES THAT IF A LANDLORD – TENANT RELATIONSHIP IS ESTABLISHED, THIS RENTAL APPLICATION WILL BE ATTACHED TO AND BECOME PART OF THE LEASE AGREEMENT AND RULES AND REGULATIONS. ANY FALSIFICATION WILL BE GROUNDS FOR IMMEDIATE EVICTION. ALL RENTAL PAYMENTS AND DEPOSITS SHOULD BE MAILED TO THE MANAGING AGENTS OFFICE.

Monthly Rent

Number of Bedrooms

Security Deposit

Select a date

Applicant's Full Name

Co-Applicant's Full Name

Applicant's Social Security

Date of Birth

Email Address

Co-Applicant's Social Security #

Applicant's Primary Phone #

Co-Applicant's Primary Phone #

Co-Applicant's Date of Birth

Applicant's Secondary Phone #

Co-Applicant's Secondary Phone #

Total Number of Persons to Occupy the Apartment Including Applicants:

Names and Ages of Children to Occupy the Apartment:

1st Child's Name

1st Child's Age

2nd Child's Name

2nd Child's Age

3rd Child's Name here

3rd Child's Age

4th Child's Name here

4th Child's Age

Address Information

Applicant's Present Street Address

City

Region/State/Province

Postal / Zip code

Is Your Present Residence:

In Your Name

In Name of Friend or Relative

Other

*If in someone else's name, can you provide paid rental receipts?

Yes

No

How long have you been at your present address?

Present Rent

Name of Owner/Managing Agent

Phone Number of Owner/Managing Agent

Employment Information

Present Employer

Title

Salary Received

Weekly

Monthly

Annually

How long have you (Spouse/Co-Habitant) been working for this Employer?

City

How long have you been working for this Employer?

Spouse/Co-Habitant Employer

Spouse/Co-Habitant Employer Phone #

Employer Phone #

Salary

Spouse/Co-Habitant City

Spouse/Co-Habitant Title

Spouse/Co-Habitant Salary Received

Weekly

Monthly

Annually

Other Information

In case of Emergency, Person to be notified

Relationship to Applicant/Co-Applicant

Address

City

State

Emergency Contact Phone #

Personal Reference

Personal Reference Telephone #

Personal Reference Address

Personal Reference City

Personal Reference State

HAS EITHER APPLICANT OR CO-APPLICANT EVER BEEN EVICTED FROM A PREVIOUS APARTMENT?

HAS EITHER APPLICANT EVER BEEN INVOLVE IN A LAWSUIT?

Ph: 973 624 3300

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