Community Name: 200 Brookline at Pierce Boston SafeRent Transaction # ________________________
Apt. Applied for:________________________________ Leasing Assoc.: ______________________________
RENTAL APPLICATION
PLEASE COMPLETE ALL FIELDS FRONT & BACK
USE N/A IF NOT APPLICABLE
APPLICANT INFORMATION- ONE APPLICATION PER ADULT APPLICANT
APPLICANT'S NAME LAST FIRST M.I. BIRTHDATE LAST 4 DIGITS OF DRIV. LIC. & STATE
/ /
EMAIL ADDRESS CELL OR HOME PHONE NUMBER
PRESENT ADDRESS APT # CITY STATE ZIP CODE
HOW LONG AT THIS ADDRESS RENT/OWN LANDLORD/MORTGAGE CO.
PREVIOUS ADDRESS APT # CITY STATE ZIP CODE
HOW LONG AT THIS ADDRESS RENT/OWN LANDLORD/MORTGAGE CO.
NAME OF PERSONS TO OCCUPY APARTMENT RELATIONSHIP DATE OF BIRTH
_______________________________________________________________________________ ________________ __________________
_______________________________________________________________________________ ________________ __________________
_______________________________________________________________________________ ________________ __________________
___
UNDERGRADUATE ______ YES
STUDENT? ______ NO IF YES, FULL TIME? ______ YES ______ NO PART TIME? ______ YES ______ NO
EMPLOYMENT
PRESENT EMPLOYER POSITION PHONE NO. NO. OF YEARS SALARY $ PER
EMPLOYER ADDRESS SUPERVISOR CITY STATE ZIP CODE
PREVIOUS EMPLOYER POSITION PHONE NO. NO. OF YEARS SALARY $ PER
PREVIOUS EMPLOYER ADDRESS SUPERVISOR CITY STATE ZIP CODE
OTHER SOURCES OF INCOME
ADDITIONAL INCOME - DESCRIBE SOURCE AND HOW TO VERIFY $ PER
PERSONAL
NO. OF VEHICLES TO BE PARKED ON COMMUNITY
VEHICLES - MAKE / MODEL (1) LICENSE NO. COLOR YEAR
MAKE / MODEL (2) LICENSE NO. COLOR YEAR
IN CASE OF EMERGENCY, CONTACT: RELATIONSHIP ADDRESS PHONE NO.
NUMBER OF PETS TYPE(S)/BREEDS NAMES(S) AGE(S) WEIGHT(S) COLOR(S) DATE OF LAST RABIES
VACCINATION(S)
HOW DID YOU HEAR ABOUT US?
PRIMARY SOURCE OTHER SOURCE
IF LOCATOR/ BROKER, PLEASE LIST NAME OF AGENT AND COMPANY
IF RESIDENT, PLEASE LIST CURRENT RESIDENT'S NAME
MOISTURE AND MOLD
MOISTURE ISSUES AND APPARENT MOLD GROWTH MAY HAVE BEEN DISCOVERED FROM TIME TO TIME WITHIN THE COMMON AREAS AND INDIVIDUAL APARTMENT
UNITS WITHIN THIS PROPERTY. AS WITH ANY OTHER PROPERTY, THERE MAY BE MOISTURE AND MOLD ISSUES AT THIS PROPERTY IN THE FUTURE AND YOUR
COOPERATION AND COORDINATION WITH THE MANAGEMENT COMPANY'S AND/OR OWNER'S INSPECTION PROCESS AND ANY NECESSARY AND APPROPRIATE
CORRECTIVE ACTION MAY BE REQUIRED. SHOULD YOU HAVE ANY MAINTENANCE ISSUES REGARDING MOISTURE AND/OR MOLD GROWTH, YOU MUST PROMPTLY
REPORT THEM TO THE MANAGEMENT COMPANY AND/OR OWNER SO THAT THEY CAN BE PROMPTLY ADDRESSED BY TRAINED PERSONNEL AND/OR SUITABLY
QUALIFIED CONTRACTORS RETAINED BY MANAGEMENT AND/OR OWNER.
RENTAL / CRIMINAL HISTORY
SAMUELS & ASSOCIATES RESERVES THE RIGHT NOT TO LEASE TO ANY INDIVIDUAL WHO HAS BEEN EVICTED, BROKEN A PRIOR LEASE, DECLARED BANKRUPTCY,
BEEN SUED FOR NON-PAYMENT OF RENT OR DAMAGE TO RENTAL PROPERTY, CONVICTED OF CERTAIN CRIMES, OR WHO IS LISTED BY THE FBI AS A FUGITIVE OR A
TERRORIST. TO DETERMINE APPLICANT'S ELIGIBILITY, PLEASE ANSWER THE FOLLOWING QUESTIONS:
HAS ANY APPLICANT EVER BEEN EVICTED OR ASKED TO MOVE OUT? YES ____ NO ____ BROKEN A RENTAL AGREEMENT OR LEASE? YES ____ NO ____ DECLARED
BANKRUPTCY? YES ____ NO ____ BEEN SUED FOR NON-PAYMENT OF RENT OR FOR DAMAGE TO RENTAL PROPERTY? YES ____ NO ____
HAS ANY APPLICANT EVER BEEN CONVICTED OF A FELONY, ANY CRIME INVOLVING VIOLENCE, ANY CRIME INVOLVING DRUGS, DAMAGE TO PROPERTY, OR A SEXUAL
OFFENSE? YES _____ NO _____ IF "YES" IS MARKED FOR ANY RESPONSE, PLEASE PROVIDE FURTHER DETAILS ON THE REVERSE SIDE OF THIS APPLICATION (E.G.,
DATE OF CONVICTION AND TYPE OF OFFENSE). FURTHER INFORMATION MAY BE REQUIRED TO DETERMINE ELIGIBILITY FOR A RENTAL.
CONSENT
APPLICANT HEREBY CONSENTS TO ALLOW SAMUELS & ASSOCIATES, THROUGH ITS DESIGNATED AGENT AND EMPLOYEES, TO OBTAIN CREDIT INFORMATION,
CRIMINAL HISTORY (INCLUDING A CONFIRMATION THAT THE APPLICANT IS NOT LISTED ON THE FBI'S "MOST WANTED FUGITIVES" AND "MOST WANTED TERRORISTS"
LISTS) AND RELATED INFORMATION REGARDING THE APPLICANT FOR THE PURPOSE OF DETERMINING WHETHER OR NOT TO ENTER INTO AN APARTMENT LEASE
WITH APPLICANT. APPLICANT UNDERSTANDS THAT, SHOULD APPLICANT LEASE AN APARTMENT, SAMUELS & ASSOCIATES AND ITS AGENT SHALL HAVE A
CONTINUING RIGHT TO REVIEW APPLICANT'S CREDIT INFORMATION, RENTAL APPLICATION, PAYMENT HISTORY, OCCUPANCY HISTORY, CRIMINAL BACKGROUND
HISTORY AND RELATED INFORMATION FOR ACCOUNT REVIEW PURPOSES AND FOR IMPROVING APPLICATION METHODS. APPLICANT UNDERSTANDS THAT
PROVIDING FALSE, FRAUDULENT OR MISLEADING INFORMATION IS GROUNDS FOR DENIAL OF RESIDENCY OR TERMINATION OF APPLICANT'S RIGHT OF OCCUPANCY.
ACKNOWLEDGEMENT
WHILE MANAGEMENT'S POLICY IS TO OBTAIN A STANDARD CRIMINAL BACKGROUND CHECK, PERFORMED BY A NATIONAL SCREENING COMPANY, ON ALL
APPLICANTS, MANAGEMENT CANNOT GUARANTEE THAT A BACKGROUND CHECK HAS BEEN PERFORMED ON ALL RESIDENTS. NOR IS MANAGEMENT ABLE TO
GUARANTEE THE ACCURACY OR COMPLETENESS OF THE INFORMATION OBTAINED FROM THE SCREENING COMPANY OR THAT THE LACK OF A CRIMINAL RECORD
GUARANTEES THE SAFETY OF ALL RESIDENTS. APPLICANT UNDERSTANDS THAT THE MANAGEMENT COMPANY AND OWNER ARE RELYING ON THE INFORMATION IN
THIS APPLICATION AND ITS ACCURACY. THE LEASE MAY BE CANCELED IF THE APPLICANT HAS MADE ANY MISLEADING OR FALSE STATEMENTS IN THIS APPLICATION.
TO BE FILLED IN BY MANAGEMENT (PROVISIONS STATED IN LEASE SHALL CONTROL)
CONTEMPLATED MONTHLY CHARGES CONTEMPLATED MOVE IN DEPOSITS, RENTS AND FEES
(DUE THE 1ST OF EACH MONTH) (DUE AT TIME OF APPLICATION OR MOVE IN)
BASE RENT $_____________________ REFUNDABLE SECURITY DEPOSIT $_____________________
PET RENT $_____________________ ADDITIONAL REFUNDABLE SECURITY DEPOSIT $0.00
OTHER RENT $_____________________ LAST MONTH'S RENT $_____________________
OTHER ____________ $_____________________
OTHER ____________ $_____________________
CONCESSIONS GIVEN KEY & LOCK CHARGE $250.00
ONE-TIME / UPFRONT $_____________________ FIRST MONTH'S RENT ADVANCE PAYMENT $500.00
MONTHLY $_____________________ OTHER _________________________ $_____________________
TOTAL DUE TOTAL DEPOSITS DUE $_____________________
MONTHLY* $_____________________ TOTAL RENTS / FEES DUE $_____________________
LEASE DATES: BEGIN _______________ END _______________ PRO-RATED RENT DUE BY MOVE IN DATE $_____________________
LESSOR ACKNOWLEDGES RECEIPT OF CHECK #_____________ AND / OR MONEY ORDER #______________ ON (DATE) _______ $_____________________
TOTAL REMAINING BALANCE (RENT, DEPOSITS, AND/OR FEES) DUE ON OR BEFORE MOVE IN DATE $_____________________
APPLICANT FURTHER UNDERSTANDS THAT MANAGEMENT WILL ADHERE TO RELEVANT STATE LAWS IN CONNECTION WITH ALL SECURITY DEPOSITS. APPLICANT
ACKNOWLEDGES AND AGREES THAT THIS APPLICATION IS A BINDING CONTRACT BETWEEN APPLICANT AND LANDLORD. IN THE EVENT THAT APPLICANT RECEIVES A
NOTIFICATION OF APPROVAL FOR TENANCY, APPLICANT MUST EXECUTE A STANDARD FORM OCCUPANCY AGREEMENT WITHIN 48 HOURS. AS PAYMENT ON
ACCOUNT FOR THE ABOVE DESCRIBED APARTMENT, APPLICANT UNDERSTANDS THAT THE PORTION OF THE FIRST FULL MONTH'S RENT IN THE AMOUNT OF $500
LISTED ABOVE MUST BE PAID TOWARD THE FIRST MONTH’S RENT WITHIN 24-HOURS OF NOTIFICATION OF APPROVAL. IF THE APPLICANT DOES NOT CANCEL WITHIN
48 HOURS, OR FAILS TO EXECUTE AN APARTMENT LEASE AGREEMENT AS AFORESAID, THE PORTION OF THE FIRST FULL MONTH'S RENT PAID WILL BE RETAINED BY
US AS LIQUIDATED DAMAGES. APPLICANT AGREES THIS IS A REASONABLE ESTIMATE OF THE LANDLORD’S DAMAGES AS A RESULT OF APPLICANT’S FAILURE TO
FULFILL APPLICANT’S CONTRACTUAL OBLIGATION AND IS NOT TO BE CONSTRUED AS PENALTY. APPLICANT UNDERSTANDS THAT ANY CHANGES TO THE LEASE
TERM, MOVE IN DATE, OR APARTMENT HOME SELECTED IS LIKELY TO RESULT IN AN ADJUSTMENT TO THE RENTAL RATE, DEPOSIT, AND/OR FEES REQUIRED.
* IN ADDITION, APPLICANT UNDERSTANDS THAT PAYMENT OF THE FOLLOWING UTILITIES IS THE SOLE RESPONSIBILITY OF THE RESIDENT: __X__ELECTRIC, ____GAS,
_X___CABLE / INTERNET, __X__TELEPHONE, __X__WATER/SEWER, ____TRASH.
APPROVALS
DATE PROCESSED__________ APPROVED_____ NOT APPROVED_____ APPROVED WITH ADDITIONAL DEPOSIT____ APPROVED W/GUARANTOR____
APPLICANT NOTIFIED BY: _________________________________________________ DATE: ________________________ TIME: ____________________
SIGNATURE OF APPLICANT SIGNATURE OF SAMUELS & ASSOCIATES AGENT
X _______________________________________________ Date ____________ X __________________________________________ Date ________
FOR OFFICE USE ONLY: GOVERNMENT ISSUED ID VERIFIED (FOR INDIVIDUALS PRESENT AT THE SITE ONLY)
NAME : ____________________________________ ID TYPE: ______________________________ LAST 4 DIGITS OF ID #: __________________
