Page 59 - 5D.Charlotte.Sydney

Pixel

Pixel

APPLICATION FOR RENTAL
Notice: All adult applicants (18 years or older) must complete a separate application for rental.
The undersigned hereby makes application to rent an Apartment at Pixel.
APPLICANT INFORMATION
LAST NAME FIRST NAME M.I. SSN DRIVER'S LICENSE #
Block Sydney K. 045-94-****
BIRTH DATE PHONE #1 ALTERNATE PHONE EMAIL
9/11/1995 (415) 260-7031 sblock@colgate.edu
CURRENT ADDRESS
STREET ADDRESS CITY
53 Park Place New York
STATE ZIP DATE IN DATE OUT MONTHLY RENT
NY 10007 current $3,850.00 / Mo.
LANDLORD NAME LANDLORD PHONE
Tribeca House (212) 233-6766
EMPLOYMENT & INCOME INFORMATION
OCCUPATION EMPLOYER/COMPANY SALARY
Product Development and Strategic Marketing Blockware $20,000.00/Yr.
SUPERVISOR SUPERVISOR PHONE START DATE END DATE
Jeff Block (415) 519-8110 current
EMPLOYER ADDRESS CITY STATE ZIP
1206 East MacArthur Street Sonoma CA 95476
EMERGENCY CONTACT
NAME ADDRESS PHONE RELATIONSHIP
Karen Block 101 Commonwealth Avenue, San Francisco, CA, (415) 305-6627 Mother
94118
BACKGROUND INFORMATION
Have you ever filed for bankruptcy?
NO
Have you ever willfully or intentionally refused to pay rent when due?
NO
Have you ever been evicted from a tenancy or left owing money? If yes, please provide Property Name, City, State, and Landlord Name.
NO
Have you ever been convicted of a crime? If yes, please provide Type of Offense, County, and State.
NO
ADDITIONAL INFORMATION
AQUARIUM? WATERBED? BOAT? MOTORHOME? MOTORCYCLE? OTHER?
NO NO NO NO NO NO
OTHER INFORMATION
HOW DID YOU HEAR ABOUT THIS PROPERTY?
Email
UNIT APPLYING FOR: PLEASE INCLUDE ANY OTHER INFORMATION YOU BELIEVE WOULD HELP TO EVALUATE THIS APPLICATION
5D I will have a guarantor .
DESIRED MOVE IN DATE: DESIRED LEASE TERM: DESIRED RENT:
9/1/1920 1 year with option to renew at same price $5,400.00

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