PINNACLE MANAGING CO.

, LLC
P.O. Box 1919
New York, NY 10116
Phone: (212) 564-2111
APPLICATION FOR RENTAL Fax: (212) 695-4848

LEASE LENGTH Submi tted By: _______________ Source: ¯ Wal k-in ¯Newspaper ¯ Super (Name)
¯One Year ¯ Two Year Approved By: ___________________ ¯ B ro ker_______ (Broker Company) ¯ Other_____________ (Describe)
ADDRESS: UNIT: SIZE: RENT: DATE:

APPLICANT INFORMATION
FIRST NAME M.I. LAST NAME JR./SR. DATE OF BIRTH SSN

W ORK PHONE CELL PHONE EMAIL

HOME PHONE

( ) ( ) ( )

CURRENT ADDRESS
STREET ADDRESS CITY STATE ZIP

LANDL ORD/ MANAGI NG AGENT NAME

L ANDL ORD/ MANAGI NG AGENT
PHONE ( )
MONTHL Y RENT DATE IN DATE OUT REASON FOR LEAVI NG

PREVIOUS ADDRESS (if less than 2 years at current)

STREET ADDRESS CITY STATE ZIP

LANDL ORD/ MANAGI NG AGENT NAME

L ANDL ORD/ MANAGI NG AGENT
PHONE ( )
MONTHL Y RENT DATE IN DATE OUT REASON FOR LEAVI NG

BANK INFORMATION
CHECKI NG ACCOUNT BANK NAME ACCOUNT NUMBER PHONE NUMBER

( )
SAVI NGS ACCOUNT BANK NAME ACCOUNT NUMBER PHONE NUMBER

( )
OTHER ACCOUNT BANK NAME ACCOUNT NUMBER PHONE NUMBER

( )

EMPLOYMENT & INCOME INFORMATION

PRESENT EMPLOYER/COMPANY OCCUPATION ANNUAL SAL ARY

SUPERVISOR NAME START DATE

SUPERVISOR PHONE
( )
PREVIOUS EMPLOYER/ COMPANY OCCUPATION ANNUAL SAL ARY

SUPERVISOR NAME START DATE

SUPERVISOR PHONE
( )
OTHER I NCOME DESCRIPTI ON ANNUAL I NCOME

GOVERNMENT HOUSI NG SUBSIDY TYPE AMOUNT

BUSINESS/PERSONAL REFERENCES
NAME ADDRESS PHONE RELATI ONSHIP

( )
NAME ADDRESS PHONE RELATI ONSHIP

( )

CO-APPLICANT INFORMATION (if applicable)

FIRST NAME M.I. LAST NAME JR./SR. DATE OF BIRTH SSN

HOME PHONE W ORK PHONE CELL PHONE EMAIL

( ) ( ) ( )
CO-APPLICANT CURRENT ADDRESS (if different)
STREET ADDRESS CITY STATE ZIP

LA NDLO RD/MA NA GI NG A GE NT NA ME LA NDLO RD/MA NA GI NG A GE NT

P HO NE (

MO NTHLY RE NT DATE IN DA TE OU T REAS ON FO R LEAVI NG

CO-APPLICANT BANK INFORMATION (if applicable)

C HE C KI NG A C CO U NT B A NK NA ME A C C OU NT NU MB E R
P HO NE NU MB E R

( )
S A V I NGS A C CO U NT B A NK NA ME A C C OU NT NU MB E R
P HO NE NU MB E R

( )
O THE R A CC O U NT B A NK NA ME A C C OU NT NU MB E R
P HO NE NU MB E R

( )

CO-APPLICANT EMPLOYMENT & INCOME INFORMATION (if applicable)

P RE S E NT E MP LO YE R/C O MP A NY O CCUPA TIO N A N NU A L S A LA R Y

S U P E RV I S O R NA ME S U P E RV I S O R P HO NE S TA RT DA TE

( )

P RE V I OU S E MP LO YE R/C O MP A NY O CCUPA TIO N A N NU A L S A LA R Y

S U P E RV I S O R NA ME S U P E RV I S O R P HO NE S TA RT DA TE

O THE R INC OME DES CRIP TIO N A NNUA L I NC OME

GO VE RNME NT HO US I NG S UBS I DY TYPE AMOUNT

OTHERS WHO WILL OCCUPY THE APARTMENT

NAME RE LA TI ONSHIP AGE

NAME RE LA TI ONSHIP AGE

EMERGENCY CONTACT
NAME A DD RE S S RE LA TI ONSHIP
PHONE
( )

PETS
DES CRIP TIO N
PETS?

YES NO

I warrant that all statements above set forth are true. I hereby give my permission to communicate with my current and former landlord for the purpose of discussing any facts and circumstances of my
current or former tenancy, as well as the other information listed above. I give my permission to communicate with my current employer(s) for purposes of verifying the information listed above. I
understand there are no limitations or restrictions regarding what may be discussed or revealed regarding my application. I am aware that a credit history, OFAC search, and landlord/tenant court record
search will be done in conjunction with my application. I am also aware that in conjunction with my application, a search will be performed with respect to my criminal conviction history (“Conviction
Report”). The Conviction Report will return information regarding (a) any conviction and/or release from incarceration within seven (7) years of the date of my application for crimes bearing a causal
connection to (i) the health and safety of persons and/or (ii) the protection of property; (b) whether I am required to be a lifetime registrant on the state sex offender registry; and/or (c) any convictions for the
illegal manufacture or distribution of a controlled substance as defined in section 102 of the Controlled Substances Act. I hereby give my consent to the Landlord to obtain my Conviction Report and
consumer credit report for the purposes of tenant screening through On-Site. I understand that I may have the right to make a written request within a reasonable period of time to receive additional, detailed
information about the nature and scope of this investigation. I further understand that if Landlord and/or On-Site request further information with respect to my Conviction Report, such information must be
provided within 48 hours of said request, and that failure to provide such information will constitute an abandonment of my application.

Pursuant to federal and state law NYC Admin. Code §20-807 et seq.:
1) If your application is denied or other adverse action is taken against you due to a screening report the landlord uses, the landlord must tell you so and how to contact the screening
company to obtain a free copy of the report.
2) You may dispute inaccurate or incorrect information on the report directly with the screening company. Our screening company is On-Site.com, P.O. Box 1504,
Los Altos, CA 94023 I Phone: (877) 222-03841 Fax: (888) 774-01441 vvww.on-site.com.
3) Annually, you may order a free screening report from www.annualcreditreport.corn

There is a nonrefundable fee of $75.00 for each credit report payable in advance. One report is required for each applicant.

____________________________________________________________ __________________________________________________________
(Signed/Applicant) Date (Signed/Co-Applicant/Guarantor) Date