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Elmira Trading Co.
212 East 14th Street
Elmira Heights, NY 14903

Rental Application Elmira Heights, NY

Amounts Due Prior To Occupancy:

First months rent: $1000

Security deposit: $1000

Pet Deposit: To be determined

Lease terms to be determined

Applicant Personal Information

Last name*

First name*

Social Security Number*

Drivers License Number w/State

Current Street Address

Current City

Current State

Phone*

Phone #2

Email*

Vehicle Information

Do you have a vehicle?*

Yes

No

If yes, Year, Make, Model

License Plate Number & State

Occupants

Will you be living alone or with other people?*

Alone

With others

If living with others please list full names of all Occupants

Pets

Do you have any pets?*

Yes

No

If Yes, please enter type and weight

Smoking

Do you or any other occupants currently smoke?*

Yes

No

If yes, what products?

Legal Action

Have you ever filed bankruptcy?*

Yes

No

If yes, explain:

Have you ever been evicted?*

Yes

No

If yes, explain:

Have you ever been convicted of a felony?*

Yes

No

If yes, explain:

Finances & Credit

Employer *

Employer #2

Gross Month Employment Income*

Other Monthly Income

Other Monthly Income Source

Do you have any loans?*

Yes

No

If yes, please provide amounts and reasons:

Do you have any credit card debt?*

Yes

No

If yes, please provide amounts and card issuers:

Do you have any other debt?*

Yes

No

If yes, please provide amounts and reasons:

What is your credit score?

Please upload a screenshot or PDF of a recent credit report with score

References

Rental Reference*

Rental Reference Phone*

Rental Reference Email

Personal Reference*

Personal Reference Phone*

Personal Reference Email

212 E. 14th Street

Elmira Heights, NY 14903

(607) 732-0257

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