Application to Rent
Greenbaum Rentals Inc.
17 Hallock Street Amherst, MA. 01002 (413) 253-1000 fax: (413) 253-8904
Email address *
Note: You must submit a check with this application: 1) DEPOSIT (Security deposit) Payable to: ________________________ $________________ (fill in two spaces below with name and amount). 2) A separate application is required for each person over the age of 18 who will reside on premises.
Start Date:
Social Security Number:
Date of Birth:
Cell Phone:
Childrens' Names and D.O.B's:
Present Address, Dates, Rent, Utilities:
Why are you leaving?
Position When Coming to Amherst?
Permanent/Parents' Address
Parent's Phone Number
Previous Address(es), Dates, Rent, Utilities:
Why did you leave?
Name of Landlord
Landlord Phone Number
Have you ever been arrested?
Have you even been evicted?
Employer Address
Employer Phone
Present Title/Position
How long at this position?
Supervisor Name:
Supervisor Phone:
Other income (all sources) :
Guarantor Address:
Guarantor Phone:
TWO Personal References (other than relatives): Name, Address, and Phone
Automobile: Make, Model, Color, Reg, State:
In consideration of the property owner’s holding this apartment/house for me as a consequence of the foregoing application, the owner shall be entitled to retain the deposit Paid herewith as liquidated damages, if I am accepted as a tenant and failto enter into the lease/rental agreement for the premises. If for any reason the landlord does not accept me as a tenant, I shall be entitled to the return of this deposit. If the lease is concluded between the parties, the deposit shall be appliedtoward the payment of the security deposit. Furthermore, by signing this form, I understand that a credit/reference check may be undertaken to determine rental history and ability to pay rent. I hereby authorize the references listed above to release credit and other appropriate information to the owner or his agents for this purpose. Electronic Signature and Date:
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