Residential Lease Application

Fill out the form below then click SUBMIT to email your application to Ellicott Development Company. By completing and submitting this online application, Applicant(s) hereby applies for, and offers to execute a rental agreement for an apartment offered by Ellicott Development Company. Applicant(s) hereby represent and warrant that all information and statements provided herein are true.

Applicant Information
Name*
First Last
Home Phone*
Mobile Phone*
Email*
Social Security Number*
Date of Birth*
Vehicle Information
Vehicle #1 Make/Model/Year
Vehicle #1 License Plate Number
Vehicle #1 License Plate State
Vehicle #2 Make/Model/Year
Vehicle #2 License Plate Number
Vehicle #2 License Plate State
Co-Applicant Information
Name
First Last
Home Phone
Mobile Phone
Email
Social Security Number
Date of Birth
Co-Applicant Vehicle Information
Vehicle #1 Make/Model/Year
Vehicle #2 Make/Model/Year
Other Intended Permanent Residents
Other Applicant Name #1
Other Applicant Name #2
Other Applicant Name #3
Description of Pets
Pet #1 - Weight/Breed
Pet #2 - Weight/Breed
Current Address
Current Address*
Street Address Address Line 2 City State ZIP Code
Monthly Payment*
Rent or Own*
- Rent
- Home Owner
Month/Year moved in*
Reason for Leaving*
Owner/Agent Name*
First Last
Owner/Agent Address*
Street Address Address Line 2 City State ZIP Code
Owner/Agent Phone*
Lender Name
Lender Address
Street Address Address Line 2 City State ZIP Code
Lender Phone
Previous Address
Address*
Street Address Address Line 2 City State ZIP Code
Monthly Payment*
Rent or Own*
- Rent
- Home Owner
Month/Year Moved In*
Reason for Leaving*
Owner/Agent Name*
Owner Agent Phone*
Lender Name
Lender Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Lender Phone
Employment Information
Status*
- Full Time
- Part Time
- Student
- Retired
- Not Employed
Occupation*
Title*
Employer*
How Long at Current Job*
Employer Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Employer Phone*
Appoximate Monthly Income*
Co-Applicant Employment Information
Status
- Full Time
- Part Time
- Student
- Retired
- Not Employed
Title
Employer
How Long at Current Job
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Approximate Monthly Income
Bank References
List only name, address and type of account. Do not include account numbers.
Bank #1 Name*
Bank #1 City/State/Branch*
Bank #1 Phone*
Type of Account*
- Checking
- Savings
- Credit
- Other
Bank #2 Name
Bank #2 City/State/Branch
Bank #2 Phone
Type of Account
- Checking
- Savings
- Credit
- Other
Credit References
List only name, address and type of account. Do not include account numbers.
Credit Reference #1 Name*
Credit Reference #1 City/State/Branch
Credit Reference #1 Phone*
Type of Account*
- Checking
- Savings
- Credit
- Other
Credit Reference #2
Credit Reference #2 City/State/Branch
Credit Reference #2 Phone
Type of Account
- Checking
- Savings
- Credit
- Other
Credit Reference #3
Credit Reference #3 City/State/Branch
Credit Reference #3 Phone
Type of Account
- Checking
- Savings
- Credit
- Other
Character References
Please include three (3) non-relative character references.
References #1 Name*
First Last
References #1 Phone*
References #2 Name*
First Last
References #2 Phone*
References #3 Name*
First Last
References #3 Phone*
Specific Location/Building Preferred
Min. Number of Bedrooms
Min. Number of Full Baths
Emergency Contact
Emergency Contact Name*
Emergency Contact Phone Number*
Comments
Any additional information you would like us to know as we process your application.
Comments
Submission of this application together with any required supporting documents, and the required security deposit is subject to approval by Landlord. If approved and the lease is executed, all movies deposited will be applied to Tenant’s Security Deposit. If applicant withdraws or fails to execute a lease within three (3) business days of an approved application, any amount deposited will be retained by Landlord as liquidated damages. By submitting this application on line, Applicant(s) hereby authorizes Landlord and/or its Property Manager to perform a credit and criminal background check of all Applicant(s). I understand I may be contacted for further information to complete these requests, if necessary.
Agree*
- Agree
Captcha

Statement of Non-Discrimination:
In accordance with the terms of the federal Fair Housing Act, the New York State Human Rights Law, and the County of Erie’s Fair Housing Law (as filed 5/23/2018), the aforementioned housing provider offers housing and services on an equal opportunity basis without regard to a person’s race, color, religion, sex, age, marital status, disability, national origin, source of income, sexual orientation, gender identity, military status, familial status, or immigration and citizenship status.

Application Disclosure:
This application must be signed by all adults who will occupy the apartment jointly and severally before it will be considered by Landlord. Submission of this application together with any required supporting documents, and the required deposit is subject to approval by Landlord. If approved and the lease is executed, all monies deposited with this application will be applied to Tenant’s Security Deposit. If applicant withdraws or fails to execute a lease within three (3) business days of an approved application, the amount deposited (as indicated below) will be retained by Landlord as liquidated damages.

By signing this application, the applicant(s) hereby authorizes Landlord and/or its Property Manager to perform a credit and criminal background check of Applicant(s).
and Applicant shall enter into a Lease for aforementioned premises.

Applicant Information

Vehicle Information

Co-Applicant Information

Co-Applicant Vehicle Information

Other Intended Permanent Residents

Description of Pets

Current Address

Previous Address

Employment Information

Co-Applicant Employment Information

Bank References

Credit References

Character References

Emergency Contact

Comments

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