Imperial Gardens Apartments Rental Application

5118 Princess Circle
Wappingers Falls, New York 12590-2914
Phone: 845-297-1033
Fax: 845-297-6646
Email: office@imperialgardensapts.com

Rental Application	Please complete all of the requested information on this form. Print, sign before a notary public, and submit with photo identification.

Size of Apartment:
You may choose
more than one.

Studio
One Bedroom

Two Bedroom
Three Bedroom

Desired Occupancy
Date: Select month
and year.

Personal Information

Applicant's Full Name:

Date of Birth (mm/dd/yy):

Marital Status:

Social Security #:

Spouse's Full Name:

Date of Birth (mm/dd/yy):

Social Security #:

Other Residents:

1. Name:	Relationship:	Age:
2. Name:	Relationship:	Age:
3. Name:	Relationship:	Age:
4. Name:	Relationship:	Age:

Residence History

Present Address:

Telephone #:

City:

State:

Zip:

Length of time at this address: Years Months

Cell Phone #:

Reason for Moving:

Rent:

Landlord's Name:

Landlord Tel #:

Previous Address:

Telephone #:

City:

State:

Zip:

Reason for Moving:

Rent:

Length of time at this address: Years Months

Landlord's Name:

Landlord Tel #:

Employment Information

Applicant's Employer:

How Long? Years Months

Employer's Address:

Employer's Tel. #:

City/State/Zip:

Supervisor:

Position:

Salary:

Spouse's Employer:

How Long? Years Months

Employer's Address:

Employer's Tel. #:

City/State/Zip:

Supervisor:

Position:

Salary:

Other Income:

Banking Information

Checking - Bank:

Account #:

Branch Address:

Savings - Bank:

Account #:

Branch Address:

Vehicle Information

Applicant's Driver's License #:

Spouse's Driver's License #:

Vehicles:	Year	Make	Model	Color	Plate	State
1.
2.
3.

Emergency Contact

Name:

Relationship:

Address:

Telephone #:

City:

State:

Zip:

The undersigned applicant hereby authorizes Imperial Gardens and its agents to request, procure and obtain investigative consumer reports and other reports and information concerning credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living of the undersigned from any credit bureau, consumer credit agency or any other entity on connection with the attached application. Such consumer report, investigative consumer report or other reports and information may be requested.

The undersigned applicant, upon request, will be informed whether or not a consumer report or an investigative consumer report was requested and if such report was requested, informed of the name and address of the consumer reporting agency to whom the request was made and which furnished the report.

Subsequent consumer reports or other reports may be requested and utilized.

Applicant's Signature: _________________________					Spouse's Signature: ___________________________
(Notarized signature)					(Notarized signature)
Date:					Date:

Notary Public:					Notary Public:
On this __________ day of _________________, 20_____ before me, the undersigned notary public, personally appeared ________________________ _________________________________________, proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/ she/ they executed the same for the purposes therein stated. WITNESS my hand and official seal.					On this __________ day of _________________, 20_____ before me, the undersigned notary public, personally appeared ________________________ _________________________________________, proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/ she/ they executed the same for the purposes therein stated. WITNESS my hand and official seal.

Agent:

Date Application Received: