Date *

MM

DD

YYYY

Name *

First Name

Last Name

Primary Phone *

Textable line preferable for communications

(###)

###

####

Submission Property Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Move-In Costs Required *

Please check all that apply

First Month's Rent

Last Month's Rent

Full Security Deposit

Partial Security Deposit (list amount in other details)

Full Broker Fee (paid by tenant)

Full Broker Fee (paid by landlord)

Half Broker Fee (split between tenant and landlord)

Heating *

Please check all that apply:

Gas

Oil

Electric

Included

Forced Air

HVAC

Radiator

Interior Features *

Please check all that apply

Living Room

Dining Room

Hardwood Floors

Tile Floors

Carpeted Floors

Eat-in Kitchen

Renovated kitchen

Full Bath

Bath

Renovated Bath(s)

Laundry in Unit

Shared Laundry (coin-op or card-op)

Shared Laundry (no charge)

Laundry Hookups (purchase own machine)

No Laundry

Other (include in other details)

Exterior Features *

Check all that apply

Front Deck

Back Deck

Private Yard

Shared Yard

Patio

Off-Street Parking (Outdoor, Designated)

Off-Street Parking (Outdoor, Tandem)

Garage Parking

1 car parking

2 car parking

3+ car parking

Other (include in details)