Name

First Name *

Last Name *

Address

Address *

Address #2

City *

State *

Zip *

Dates of Current Occupancy - From *

To *

Email *

Phone *

Date of Birth *

Social Security Number *

Drivers License Number *

Drivers License State *

Upload Front of Drivers License:*

(PDF, PNG or JPG only. 5MB Max.)

Automobile: Year/Make/Model *

Automobile: Registration Number and State *

How did you hear about us? *

Present Landlord Information

First Name *

Last Name *

Address

Address *

Address #2

City *

State *

Zip *

Phone *

Start Date of Current Occupancy *

Former Landlord Information

First Name *

Last Name *

Address

Address *

Address #2

City *

State *

Zip *

Phone *

Occupancy Dates - From *

To *

Employment Information

Current Employer *

Address

Address *

Address #2

City *

State *

Zip *

Phone *

Occupation *

Type of Business *

Monthly Salary *

Length of Employment *

Employment Information

Former Employer *

Address

Address *

Address #2

City *

State *

Zip *

Phone *

Length of Employment *

In Case of Emergency Notify

First Name *

Last Name *

Address

Address *

Address #2

City *

State *

Zip *

Phone *

Financial References

Credit Reference *

Address

Address *

Address #2

City *

State *

Zip *

Phone *

Checking Account

Bank - Checking Account *

Bank - Checking Account # *

Address

Address *

Address #2

City *

State *

Zip *

Savings Account

Bank - Savings Account *

Bank - Savings Account # *

Address

Address *

Address #2

City *

State *

Zip *

NAMES OF ALL CO-TENANTS (EACH ADULT MUST FILE A SEPARATE APPLICATION)

Building
RegencyChiswick

Apartment Number *

Apartment Type
Studio1 Bed2 Bed

Total Number of Occupants *

Number of Adults *

Number of Pets *

Names and Ages of Minor Children

Occupancy Date

Rent Begins Date

Term of Lease - From

To

Are you a Convicted Felon?
Yes (Please Submit Detail of Conviction(s) below)No

Conviction Details

Rental Disclaimer - Base rent and Other Monthly Charges are due and payable on the first day of each month in advance. Pursuant to Massachusetts law, the Management shall not make any inquiry concerning the race, religious creed, color, national origin, sex, sexual orientation, age, (except If a minor) ancestry or marital status of the applicant, or concerning the fact that the applicant is a veteran or a member of the armed forces or is handicapped. The applicant authorized the Management and/or Renting Agency to obtain or cause to be prepared a consumer credit report relating to the applicant. Neither the Owner nor the Management is responsible for the loss of or damage to personal belongings of any kind caused by fire, theft, smoke, water, steam, defective refrigeration, elevators, or otherwise, unless caused by their negligence while on the leased premises or in any storage space in the building or for any personal injury unless caused by the negligence of the Lessor, Management recommends Renters Insurance. The undersigned warrants and represents that all statements herein are true and agrees to execute upon presentation a Rental housing Association lease or Tenancy at Will agreement in the usual form, a copy of which the applicant has received or has had occasion to examine, which lease or agreement may be terminated by the Lessor If any statement herein made is not true. Deposit is to be applied as shown above, or applied to actual damages sustained by the owner, except it is to be refunded if said application is not accepted by the owner. This application and deposit are taken subject to previous applications. The renting agent is an independent contractor and has no authority to make any representation concerning the premises; the renting agent is only authorized to show the apartment for rent and to assist in the screening of rental applicants.

I have read and accept the Rental Disclaimer
YesNo

To Be Completed by Management Company

THIS APPLICATION MUST BE ACTED UPON BY THE OWNER ON OR BEFORE

Renting Agent

Signature