Madison Development Company / Application

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Manager Name: empty
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After you press the "Print Application" button, please be sure to PRINT generated application and fill in the boxes with black borders. Please sign the form on the bottom and mail to us.

Notice: Co-Applicant must complete a separate Rental Application Form

The undersigned hereby makes application to rent unit number

# Of Occupants

Requested Occupancy Date

Monthly Rental $

Parking $

Storage $

Rent Special $

Total Monthly $

Full Name:

Phone:

Date of Birth:

Name(s) of Co-Applicant:

Relationship to Applicant:

Names of All Other Occupants (Minors or Dependents):

How Many Pets Do You or Other Occupants Own?

Type of Pet(s) (Restrictions apply):

Current Address:

City:

State:

Zip:

Month & Year Moved In :

Reason for Leaving :

Owner or Agent :

Phone :

Monthly Payment $

Previous Address:

City:

State:

Zip:

Month & Year Moved In :

Reason for Leaving :

Owner or Agent :

Phone :

Monthly Payment $

Previous Address:

City:

State:

Zip:

Month & Year Moved In :

Reason for Leaving :

Owner or Agent :

Phone :

Monthly Payment $

Your Employment Status:

Full-Time

Part-Time

Student

Retired

Not Employed

Current Employer

Phone:

Address:

City:

State:

Zip:

Dates Employed / From : To:

Posititon:

Supervisor:

Gross Monthly Salary $

Household Gross Monthly Income $

Previous or 2nd Employer

Phone:

Address:

City:

State:

Zip:

Dates Employed / From : To:

Posititon:

Supervisor:

Gross Monthly Salary $

Household Gross Monthly Income $

If there are other sources of income you would like us to consider, please list income, source and person (Banker, Employer, etc.) who we could contact for confirmation. You do NOT have to reveal alimony, child support or spouse's annual income unless you want us to consider it in this application.

Amount $

Source:

Have you ever:
Been evicted or asked to move out? Yes No	Been sued for non-payment of rent? Yes No
Been Sued for damage to rental property? Yes No	Broken a Rental Agreement or Lease? Yes No
Been convicted of a crime in the past 7 years ? Yes No If so ,what?	Declared Bankruptcy? Yes No

How did you hear about our community?:

If Referral, who?

If management has any questions about your application, please give Phone Numbers where you can be located.
Day Phone:	Evening Phone:	Other Phone:

Who may we contact in case of Emergency?

Name:

Relationship:

Complete Address:

Home Phone:

Work Phone:

Other Phone:

Total Number of Vehicles (including Company Vehicles):
Make/Model:	Year:	Color:	Tag No./State:
Make/Model:	Year:	Color:	Tag No./State:
Car, Motorcycle, Etc.:

Please give any additional information that might help management evaluate your application:

I hereby apply to lease the above described premises for the term and upon the conditions above set forth and agree that the rental is to be payable the 1st day of each month in advance. I hereby acknowledge that $35.00 of the $100.00 issued to MDC by me is to be used for the sole purpose of my application fee and is non-refundable. I hereby deposit $65.00 of the $100.00 as earnest money to be refunded to me if this application is not accepted within 7 business banking days. Upon acceptance of this application, this deposit shall be retained as part of the security deposit. When so approved and accepted I agree to lease for 12 months before possession is given back and to pay the balance of the security deposit within 7 business banking days after being notified of acceptance, or the earnest money will be forfeited as liquidated damages in payment for the agent's time and effort in processing my application, including making necessary investigation of my credit, rental history & employment status. If the owner or agent does not approve this application, the earnest money will be refunded, the applicant thereby waiving any claim for damages by reason of nonacceptance.

I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE CONTENTS OF THIS RENTAL APPLICATION AND ALL OF THE ABOVE INFORMATION, TO THE BEST OF MY KNOWLEDGE, IS TRUE AND CORRECT.
I ALSO ACKNOWLEDGE THAT IF AT ANY TIME FOR ANY REASON I DECIDE NOT TO RENT THE ABOVE SAID SUITE, I WILL FORFEIT ALL EARNEST MONEY.

Fee paid in checks (amounts: $35 and $65) or Money Order (amount $100) NO CASH ACCEPTED

Authorization for release of information

Purpose: The owner and manager(s) of Madison Development Company and Larchmont Apartments may use this authorization and the information obtained with it to administer and enforce rules and policies related to the rental of apartment suites by the above referenced organization.

Authorization: I authorize and consent to an investigation on all statements and information contained in this application by, Madison Development Company about me (us) or my family that is pertinent to the rental of property owned and/or managed by such organizations

Information Conveyed and/or Inquiries may be made about:

Banks and other financial institutions
Credit Bureaus
Employers, present and past
Landlords, present and past
Utility companies
Providers of: Child support, credit, childcare, alimony and welfare.

Local Taxing Authority: In cities where municipal income tax exists, we are obligated to release to the local taxing authority the names and social security numbers of all leaseholders.

Conditions: I agree that photocopies of this authorization may be used for the purpose stated above. If I do not sign this authorization, I understand I may be denied occupancy of rental property owned and/or managed by the above referenced organizations.

After you press the "Print Application" button, please be sure to PRINT generated application and fill in the boxes with black borders. Please sign the form on the bottom and mail to us.