STANTON REALTY, INC. APPLICATION FOR RENTAL

Mail to P.O. Box 1965
Westerly, RI 02891
Fax to 401-596-2885 or Email

SECTION A:  PERSONAL INFORMATION

NAME & CURRENT ADDRESS OFAPPLICANT(S)____________________________
__________________________________________S. S. #__________________________

CIRCLE ONE:  RENT OWN/HOW LONG? _____ MTHLY PAYMENTS $_________

IF RENTING, NAME & TEL. # OF lANDLORD_______________________________
DAY TEL. # WHERE YOU CAN BE REACHED________________________________

# OF BEDROOMS DESIRED _____ # OF ADULTS______ # OF CHILDREN ______
LENGTH OF LEASE DESIRE      (MIN. 6 MTHS)     FROM ______ TO ___________

*** The following questions need only be answered voluntarily ***

MARITAL STATUS______________                       DATE OF BIRTH______________

*****************************************************************************

SECTION B:  EMPLOYMENT HISTORY

PLEASE CIRCLE ONE:  SELF-EMPLOYED     OUTSIDE EMPLOYED      RETIRED
NAME  & ADDRESS OF PRESENT EMPLOYER OR BUSINES NAME:
_________________________________________________________________________

LENGHT OF EMPLOYMENT OR BUSINESS OWNERSHIP__________
NAME & TEL. # OF CONTACT PERSON____________________________________

AVERAGE INCOME: $__________WEEKLY     MONTHLY or  OTHER
IF MARRIED, PLEASE PROVIDE SPOUSES EMPLOYMENT INFO, IF APPLICABLE
___________________________________________________________________________
REFERENCE NAMES & TEL. #'S
1.__________________________________________________________________________
2.__________________________________________________________________________
3.__________________________________________________________________________

***Applicant(s) hereby give Stanton Realty, Inc. permission to contact any of the above persons to verify the information provided above.***

______________________________________________    ____________________________
Applicant #1                                                                             Date
______________________________________________    ____________________________

Applicant #2                                                                              Date

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