Please print this application for all residential rentals.Once completed and signed, fax to the number below.
Gate House Realty
492 Main Street, Beacon, NY 12508
Phone (845) 831-9550 Fax (845)831-9552
Rental Application
Apartment Address_____________________________________________
Date you need Length of lease
to Move in__________________________ Requested ________________
Name_____________________________________________________________
Current Address________________________________________________
City ___________________________________State______ Zip___________
Home Phone_____________________ Work Phone__________________
Cell Phone______________________________________________________
Email Address___________________________________________________
Date of Birth_______________ Social Security___________________
Name (spouse/roommate)_______________________________________
Current Address_______________________________________________
City ____________________________________State______ Zip_________
Home Phone_____________________Work Phone__________________
Cell Phone_____________________________________________________
Date of Birth________________Social Security__________________
Email Address__________________________________________________
Do you have any pets? ___________ Type_________________________
Name(s) ________________________________________ Age(s)__________
Name of present landlord_____________________________________
Telephone______________________Term of occupancy___________
Why are you moving?___________________________________________
Automobile_____________________________ Year___________________
License #__________________________ State_______________________
Business Verification
Present Employer______________________________________________
Phone_________________________ Address_________________________
Position/Title_________________________ Time Employed_________
Net Monthly Income____________________________________________
Present Employer (spouse/roommate)_________________________
Phone________________________ Address__________________________
Position/Title_________________________ Time Employed_________
Net Monthly Income____________________________________________
Personal References
Name________________________________ Phone_____________________
Relationship____________________________________________________
Name________________________________ Phone_____________________
Relationship____________________________________________________
Professional References (no relations, please)
Name________________________________ Phone_____________________
Relationship____________________________________________________
Name________________________________ Phone_____________________
Relationship____________________________________________________
Person to notify in case of an emergency
__________________________________________________________________
__________________________________________________________________
I, the undersigned, do hereby certify the facts set forth in the above inquiry are true and accurate.
I authorize you to contact my prior landlord and check all additional references provided in this form.
I also authorize you verify my financial and credit record. By signing this form I also understand that
I am to pay Gate House Realty a fee equal to one months rent should I become a tenant.
Prospective Tenant_______________________________ Date_________
Prospective Tenant_______________________________ Date_________
10/07