Rental Application

One application per adult occupant · 18+

Thank you for your interest in Brickfield Residences. Please complete every section. A separate application is required for each adult who will live in the unit. A non-refundable screening fee applies.

Applicant

Full legal name

Date of birth

Phone

SSN / ITIN

Co-applicant (if applying together)

Co-applicant phone

The residence

Unit / floor plan desired

Desired move-in

Lease length

Current & prior housing

Address

Landlord / manager

Landlord phone

Rent / dates

218 Mercer St, Apt 3 — current

Hillcrest Mgmt

(555) 300-1180

$1,950 · 2yr

77 Aldine Ave — prior

R. Mehta (owner)

(555) 221-6604

$1,600 · 3yr

Employment & income

Employer

Position

Gross monthly income

Years there

Supervisor & phone

Vehicles, pets & emergency contact

Vehicle (make / plate)

Pets

Smoking & occupancy — check all that apply

Non-smoking household 1 occupant 2 occupants Children under 18 Renter's insurance

Emergency contact

Their phone

Authorization & signature

Authorization to verify, screen & obtain reports

I certify that the information in this application is true and complete. I authorize Brickfield Residences and its agents to verify all information provided, to contact my employer and current and prior landlords, and to obtain a consumer credit report, rental-history report, and criminal-background report for the purpose of evaluating my tenancy. I understand the screening fee is non-refundable and that false or incomplete information is grounds for denial or for termination of any resulting tenancy.

Applicant signature

Date

Co-applicant signature

Date

Brickfield Residences Equal Housing Opportunity We do not discriminate against any protected class.