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Brokerage Agreement /Application MAIN LEASING OFFICE
TOLL FREE PHONE: 914-834-8200
FAX: 914-834-8065
 
Date: ______ How did you here about us:_____________ Preferred move-in date: _____ Bldg/Unit #: ____
Applicant Name(s)
Name: Name:
Address: Address:
City:_________ State: _________ Zip:_________ City:_________ State: _________ Zip:_________
Phone:__________ Other Phone: __________ Phone:__________ Other Phone: __________
Soc. Sec. #: _____ - _____- _____    DOB __________ Soc. Sec. #: _____ - _____- _____    DOB __________
 
Tenant History
Reason for move: Reason for move:
Present Landlord: Present Landlord:
Phone: Phone:
Years at present address:_____ Current Rent:______ Years at present address: _____ Current Rent:______
Prior Add: (if less than 2 yrs). Prior Add: (if less than 2 yrs).
Years at Prior Address: Years at Prior Address:
Previous Landlord: ____________ Phone: __________ Previous Landlord: ____________ Phone: __________
Has either LL ever sued for non-payment of rent ? Has either LL ever sued for non-payment of rent ?
 
Employment Information
Employer: Employer:
Address: Address:
Position: Position:
Salary: Per: Salary: Per:
How long employed: How long employed:
Supervisor: Supervisor:
Phone: Phone:
Other source of income: Other source of income:
 
Credit Information
Credit Cards: Credit Cards:
Bank Name: _______________ Savings Acct#:_______________ Bank Name: _______________ Savings Acct#:_______________
Bank Name: _______________Checking Acct#:_______________ Bank Name: _______________Checking Acct#:_______________
 
Occupancy Details
Names of all persons who will occupy apartment: Soc. Security #: Relationship to Applicant: Age:
       
       
       
       
       
 
Auto Information
Auto Make Model Year Plate Auto Make Model Year Plate
               
               
 
Pet Information
Pet Type
   
   
 
Emergency Contacts (in case of emergency contact)
Name: Phone:
Name: Phone:
 
Guarantor Information
Name of Guarantor: Phone:
Address: Social Sec. # ____ - ____ - ____
I hereby authorize Landlord authorizes the Landlord and its associates, credit bureau’s, Banks, Financial Institutions, Attorney’s, Accountants and other persons or institutions with whom I am acquainted to furnish any information regarding me. I am willing that a photocopy or facsimile of this authorization be accepted with the same authority as the original.
Signature of Guarantor x______________________
 
Character Reference
Character Reference Name: Character Reference Name:
Address:
Phone:
Address:
Phone:
 
It is hereby agreed that upon execution of this application, said applicant shall deposit with the Landlord, and/or its agent, a non-refundable fee of $ 40.00 per applicant to pay for the cost of checking the applicant’s credit history. Applicant hereby authorizes the Landlord and its associates, credit bureau’s, Banks, Financial Institutions, Attorney’s, Accountants and other persons or institutions with whom I am acquainted to furnish any information regarding me. I am willing that a photocopy or facsimile of this authorization be accepted with the same authority as the original. It is agreed that this application is subject to acceptance or rejection at any time by the Landlord at its sole discretion. This fee shall be non-refundable if the Applicant withdraws this application for any reason whatsoever.
 

Applicant Signature: ________________________________________

Co-Applicant: _____________________________________________
 

HarborView Properties

2406 Boston Post Road, Larchmont, NY 10538

914-834-8200

The information contained herein is subject to errors, omissions, changes in terms and conditions, prior sale, and/or withdrawal from market, all without notice. All information is derived from sources deemed reliable, however, no warranties are either expressed or implied. Prospective purchasers should rely on their own verification of the facts before committing themselves financially or otherwise.