NOTE: This is not an encrypted(secure) form. Please feel free to print out this form
and fax it to us or bring it to our office
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| First Name |
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| Last Name |
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| Home Phone |
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| Cell Phone |
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| Email Address |
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| Are you over 18 years of age? (Y/N) |
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| Present Address |
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| City |
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| State |
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| Zip Code |
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| Present Landlord |
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| Landlord's Phone |
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| Landlord's Address |
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| City |
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| State |
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| Zip |
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| Former Landlord |
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| Landlord's Phone |
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| Landlord's Address |
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| City |
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| State |
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| Zip |
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| Make |
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| Year |
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| Registration State |
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| Registration Number |
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| Current Employer |
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| Employer Phone |
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| Employer Address |
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| City |
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| State |
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| Zip Code |
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| Date Hired |
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| Occupation |
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| Salary |
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| Length of Employment |
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| Former Employer |
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| Length of Employment |
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| Employer Phone |
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| Employer Address |
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| City |
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| State |
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| Zip Code |
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| Reference Name |
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| Phone |
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| Address |
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| City |
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| State |
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| Zip Code |
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| In case of emergency, contact |
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| Relationship |
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| Phone |
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| Address |
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| City |
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| State |
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| Zip |
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| Name of Creditor |
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| Phone |
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| Address |
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| City |
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| State |
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| Zip |
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| Name |
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| Age |
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| Name 2 |
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| Age |
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| Name 3 |
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| Age |
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| Name 4 |
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| Age |
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| Name 5 |
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| Age |
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| Name 6 |
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| Age |
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| Number of Pets |
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| Are you a convicted felon? (Y/N) |
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| If "Yes", please submit detail of conviction |
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Base rent and other monthly charges are due and payable on the first day of each month in advance.
Pursuant to Massachusetts law, the Management shall not make any inquiry concerning race, religious creed, color, national origin, sex, sexual orientation, age, (except if a minor), ancestry or marital status of the Applicant or concerning the fact that the Applicant is a veteran or a member of the armed forces or is handicapped. The Applicant authorizes the Management and/or Renting Agency to obtain or cause to be prepared a consumer credit report relating to the Applicant.
Neither the Owner nor the Management is responsible for the loss of personal belongings caused by fire, theft, smoke, water or otherwise, unless caused by their negligence.
The undersigned warrants and represents that all statements herein are true and agrees to execute upon presentation a Rental Housing Association lease or Tenancy at Will agreement in the usual form, a copy of which the Applicant has received or has had occasion to examine, which lease or agreement may be terminated by the Lessor if any statement herein made is not true. Deposit is to be applied as shown above, or applied to actual damages sustained by the Owner, except it is to be refunded if said application is not accepted by the Owner. This application and deposit are taken subject to previous applications. |
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By typing my name and checking this box
I certify that I have read the above statement and agree to its terms. |
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I accept the above terms (please type your full name, or sign it if you are sending in this form by fax or mail): |
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| Date |
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