Rental Application

INSTRUCTIONS: Please complete all sections below. Any questions that do not apply, place "N/A" in the space provided. Thank you for your interest in Madison Barracks. Return this application to: Madison Barracks, 85 Worth Road, Sackets Harbor, New York, 13685.

Apartment style & size desired:
Desirable date of occupancy:
Contact telephone number:

Personal Information

Applicant's Full Name
SSN#
Date of Birth
Marital Status
Co-Applicant's Full Name
SSN#
Date of Birth
Marital Status
 
Other Residents
Relationship

Date of Birth
1.
2.
3.
4.
 
Do You Have Any Pets?
 Yes No
If Yes, How Many?
Please Describe:

Residential History

PLEASE INDICATE IN DESCENDING ORDER...
Present Address
Length of Time
Landlord/Mortgagor
Telephone #
Monthly Payment
Reason for Moving
Previous Address
Length of Time
Landlord/Mortgagor
Telephone #
Monthly Payment
Reason for Moving
Previous Address
Length of Time
Landlord/Mortgagor
Telephone #
Monthly Payment
Reason for Moving

Employment History

Applicant's Employer
Length of Time
Address
Work Phone
Position
Supervisor
Co-Applicant's Employer
Length of Time
Address
Work Phone
Position
Supervisor

References

Bank:
Bank Name
Address
Checking Account Number
Savings Account Number
Credit Reference
Account Number
Address
Date Opened
Other reference
Address

Loans:
 
Institution
Address
Payment
Balance
1.
2.
3.

Other Information

Applicant's Drivers License # Co-Applicant's Drivers license #

Automobiles:
Make
Year
Color
Plate #
State

Applicant's Yearly Income
Total Household Income

Comments

In Case of Emergency, Contact
Relationship
Address
Phone #

This information is being processed for review and is being accompanied with an applicant's deposit to hold a specific apartment. This deposit is nonrefundable unless application is rejected by owner for specific reason provided within the legal parameters of New York State Law. Prospective tenant/applicant has been informed of this policy and agrees to this deposit provision. Once application/applicant is approved by owner, this deposit will be the apartment's security deposit and is to be considered such and is then subject to all conditions and terms of the lease.

I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND I UNDERSTAND THAT THIS APPLICATION MAY BE REVOKED IF ANY INFORMATION FURNISHED UPON THIS APPLICATION IS FOUND TO BE FALSE. I AUTHORIZE YOU TO CONTACT ANY REFERENCES LISTED ON THIS APPLICATION.

   
 
Applicant's Signature Date
Co-Applicant's Signature Date

Investigations By:

Accessible Information Management (AIM)
Investigation Company License #955
Nashville, Tennessee 37216
(615) 227-6100 Tel/ (615) 258-2582 Fax
or Toll Free
(866) 227-6104 Tel/ (866) 258-2584 Fax

The undersigned hereby gives permission to Accessible Information Management (AIM), its employees, agents and MADISON BARRACKS (Madison Barracks Associates, Harbor View Homes LP, Lakeview Homes LP) to complete a full investigation of my application by whatever means deemed necessary. This will include, but is not limited to, employment, including salary, rental verification, a credit report, criminal background search, bankruptcy, and collection/judgment verification and verification of any other things deemed necessary. The undersigned further understands that any and all records found will be submitted to MADISON BARRACKS and any misrepresentations or omissions can result in the declination of my application.

Applicant's Full Name
SSN#
Date of Birth
Driver License #
Current Address
Previous Address
Nick Names, Maiden Names,
Other Married Names
Daytime Telephone #
May we call you at this #
 Yes No

   
 
Applicant's Signature Date
Witness Date

-- FOR OFFICE USE ONLY --

Date of Application
Application Received By

REFERENCE VERIFICATION
APPLICATION
DEPOSITS
   
Present Address
Previous Address
Employment
Co-Applicant Information
Bank: Checking/Savings
Credit
Approved
Not Approved
Date of Decision
Signature
Leasing Entity
Apt. Address
Date of Occupancy
Date
Amount