Web:  www.newburyrealtygroup.com       E-mail:  esikorski@newburyrealtygroup.com

I have read and agree to the Application Agreement. Click Here to read Application Agreement.
Application Fees are 20.00 per person over the age of 18 in the household.
(NOTE:  An application will not be processed until fees are received.)
Property Information
Property Address:  
Earliest date you will take occupancy:
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Date Submitted

05-12-2021
Applicant type: Individual   Co-Applicant
Applicant Information
First:
Middle:
Last:
Date of Birth:
Click Here
SSN:
Home Number:
Cell Number:
Email:
Driver License #:
State:
Expires: Click Here
Automobile Information
Make:
Model:
Year:
Color:
License plate#:

Make:
Model:
Year:
Color:
License plate#:

Any other name(s) used (including maiden name): 
Residential History
Current Address
Street1:
Street2:
City:
State: Zip:
Residency: Rent   Own
Previous Address
Street1:
Street2:
City:
State:
Zip:
Residency:
Rent   Own
Employment Information
Current Employer
Employer:
Address:
City:
State:
Zip:
Phone Number:
  Ext:
Personnel/HR Number:
  Ext:

Title/ Position:

Monthly Income:
Start Date:
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Previous Employer
Employer:
Address:
City:
State:
  Zip: 
Phone Number:
  Ext:
Personnel/HR Number:
  Ext:

Title/ Position:

Monthly Income:
Start Date:
Click Here
End Date:
Click Here
Applicant Questions
Have you ever been asked to move out of a residence?
Yes   No

Have you ever been party to an eviction?
Yes   No
Are you a registered sex offender?
Yes   No
Have you or any member of your household been convicted or pleaded no contest to a felony?
Yes   No


Do you have liquid furniture? (i.e. waterbed)
Yes   No

Do you have renter insurance?
Yes   No
Have you ever filed bankruptcy?
Yes   No
Have you ever had any collections?
Yes   No
Do you have Pets?
Yes   No
Other Occupants (Type a last name then hit Tab to add another occupant.  The maximum is three.)
Please list all people who will reside in the residence:
First: MI: Last:   Relation: Date of Birth: Click Here Gender:
Emergency Contacts
Emergency Contact:
First:
Middle:
Last:
Home Phone:
Cell Phone:
Street1:
Street2:
City:
State: Zip:
Nearest Relative (Not residing in the apartment.):
First:
Middle:
Last:
Home Phone:
Cell Phone:
Street1:
Street2:
City:
State: Zip:

Financial Information
Bank NameAccount NumberPhone
Credit Reference NameAccount NumberBalance




Do you own a home or other real estate? Yes   No

Additional Income SourceMonthly Income
Pension
Social Security and/or SSI
Alimony
Child Support
AFDC/Government Assistance
Unemployment Compensation
Other
Additional Comments or Notes
Application Completion

DISCLOSURE AND AUTHORIZATION

The undersigned declares that the information on this rental application is true and correct, and understands that false statements may result in rejection of this and any future applications for housing we manage. The undersigned does further understand that all persons or firms associated with may freely give any requested information concerning me. I waive all right to action for any consequences resulting from releasing such information.

I also hereby authorize Newbury Realty Group to verify my past and present employment earnings records, bank statements, previous residences and or any information given for the purposes renting and or lease through Newbury Realty Group including but not limited to a credit check. I further understand and agree that Newbury Realty Group will rely upon this Rental Application as an inducement for entering into a rental agreement or lease and I warrant that the facts contained in this Application are true. If any facts prove to be untrue, Newbury Realty Group may terminate my tenancy immediately and collect from me any damages incurred including reasonable attorneys fees resulting there from. You are also herein notified that a negative credit report reflecting your credit record may be submitted in the future to a credit reporting agency if you fail to fulfill the terms of your rental obligations or if you default in those obligations in any way. Newbury Realty Group welcomes all applicants and supports fair housing. We do not refuse to lease or rent any housing accommodations or property nor in any other way discriminate against a person because of sex, marital status, race, creed, religion, age, familial status, physical or mental handicap, color or national origin.

Notice is herby given of the contractual relationship between the Property Owner and Newbury Realty Group. Newbury Realty Group is an exclusive agent of the Property Owner and represents the Property Owner's interest in any and all rental transactions.

Investigational Background Search Disclosure

Newbury Realty Group conducts applicant screening on persons applying to live in our managed properties, such screenings may include criminal background investigations.  It's Newbury Realty Group's policy not to accept prospective residents who have been charged with and or convicted of certain felonies and or misdemeanors.  Prior to acceptance of an applicant, Newbury Realty Group may use an independent consumer reporting agency to search public records which may contain criminal background information regarding the applicant.  Newbury Realty Group will determine if the criminal background information pertains to the applicant and if the report indicates that one or more such felony and or misdemeanor records were found.  Newbury Realty Group will then compare the records to Newbury Realty Group's established acceptance policies to determine whether or not the applicant may be accepted.  If your application is declined based on the discovery of public records that indicate an unacceptable criminal background, you will be given the name, address, and telephone number of the consumer reporting agency that provided the criminal background report to Newbury Realty Group.  An applicant who is declined based on a criminal background may obtain a free copy of the report and may initiate a reinvestigation to have any erroneous information contained in the report corrected.  The consumer reporting agency will advise you of the procedures that you should follow in order to do so.

Valid Photo Identification must be presented prior to final approval of this application.

I, the undersigned Applicant, agree to the above terms and do hereby swear (or affirm) that the information supplied herein is true and complete, to the best of my knowledge and belief.  By clicking "Apply Now" you agree to the terms stated above.  Please enter your full name to signify your digital signature, thereby confirming that you have read and agree with all the above statements and have provided complete and accurate information.  Applicant authorizes verification of references given and declares that the statements made in this application are true and correct and agrees that the landlord may terminate the contract entered into in reliance on any misstatement made in this application.


APPLICANT SIGNATURE: 




   
Database Name:  NEW_Westwood_Associates_LLC