*Which Property you are Applying for? 128-130 West Lincoln Avenue 428 Charlotte Avenue 505 West Southern Avenue 507 West Southern Avenue 1919-1921 Riverside Drive 411-415 Allen Street 417-419 Allen Street 421 Rose Street 603 Thomas Avenue 604-606 Thomas Avenue 608-610 Sixth Avenue 608 Rose Street 737-739 West Third Street 742 West Third Street 760 West Third Street 870 West Fourth Street 878 West Fourth Street 937 West Fourth Street 1024 West Fourth Street 1028 West Fourth Street 1032 West Fourth Street 1036 West Fourth Street 1134 West Fourth Street 1140 West Fourth Street 1142 West Fourth Street 1259 West Fourth Street 934 Vine Avenue 955 Vine Avenue 962 Vine Avenue 963 Vine Avenue 965 Vine Avenue 966 Vine Avenue 1020 Vine Avenue 1022 Vine Avenue 1060 Vine Avenue 1062 Vine Avenue 1064 Vine Avenue 1068 Vine Avenue 1070 Vine Avenue 1221 Hadley Street 1223 Vine Avenue 823 West Second Street 846 West Second Street     *Apt No.: N/A Apt. 1 Apt. 2 Apt. 3 Apt. 4 Apt. 5 Apt. 6 Apt. 7 Apt. 8 Apt. 9 Apt. 10 Apt. 11 Apt. 12

1.  APPLICANT INFORMATION:

*First Name:    *Middle:   *Last Name:

       *Phone: (xxx-xxx-xxxx)         E-mail Address:

         *SSN.: (xxxxxxxxx)                *Date of Birth:  (MMDDYYYY)

*Drivers License No.:      *State:

2.  CURRENT LANDLORD INFORMATION:

 *Landlord's Name:    *Phone: (xxx-xxx-xxxx)

 *Current Street Address:    Apt No.:

                   *City:     *State:     *Zip:

               Dates:   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec     2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035   to  Current Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   Current 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036

 *Monthly Rent:  *Utilities You Pay:  Heat Electric Gas Oil Water Sewer Garbage Cable/Internet Phone/Cellular (Press & Hold Shift for Several Selections)

 *Why are you moving?:    

 *Number of Occupants?  *Adults  1 2 3 4 4+ N/A     *Children  1 2 3 4 4+ N/A   Children Ages?

3.  VEHICLE(S) INFORMATION:

  Make:     Model:     Year:     

 Color:   License Plate No.:     State:

Vehicle Registered To: First Name:    Last Name:

4.  EMPLOYMENT & INCOME INFORMATION:

*Name of Current Employer:

         *Address of Employer:  

              *Supervisor Name:   *Supervisor Phone: (xxx-xxx-xxxx)

 Dates of Employment: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035   to  Current Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Current 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035   *Monthly Net Income: $

Other Type of Income:           Monthly Net Income: $

Other Type of Income:           Monthly Net Income: $

Other Type of Income:           Monthly Net Income: $

5.  CREDIT INFORMATION:

*Have you ever been evicted? PLEASE CHOOSE 1 Yes No

*Have you ever declared Bankruptcy? PLEASE CHOOSE 1 Yes No

*May we conduct a Background Check? PLEASE CHOOSE 1 Yes No

*Do you have a Credit Card? Yes No

Bank Name:  Phone:

    Address:     State:     Zip:

   Checking Account Number:    Savings Account Number: 

 Do you object to a 1-year lease agreement? Yes No  

 *What date are you looking to move in?  (MMDDYYYY)

6. *Please let us know how you heard about us. PLEASE CHOOSE 1 Open House Flyer/Mailing Word of Mouth/Friend Signs on Buildings Internet Search Billboard Phonebook Other

                                        (NOTE: HOLD down the CTRL key for multiple selections)

7.  Please list any additional questions or comments you may have: (80 characters max per line)

 Line 1:

 Line 2:

 Line 3:

8.  Applicant understands there is a $25 application fee which must paid to ECM Realty before this application will be considered.

   Applicant understands ECM Realty will conduct a complete financial, civil, and criminal background check.

   Signature (Required): By typing my name below, applicant agrees that all information is true, complete, and correct.

*Full Name:      *Date:  (MMDDYYYY)

Please check the form for errors and completion before submitting.

Thank You.