Application

Thank you for your interest in one of our properties and allowing Intracoastal Realty the opportunity to provide rental services to you. Please read the Application Process prior to applying.

Property Location

Personal Information

First Name*

Last Name*

Date of Birth*

Marital Status*

Phone*

E-Mail*

SSN*

Other Occupants

First Name

Last Name

Birthdate

SSN

First Name

Last Name

Birthdate

SSN

First Name

Last Name

Birthdate

SSN

First Name

Last Name

Birthdate

SSN

Current Residence

Address*

City*

State *

Zip *

Move in Date*

Current Landlord*

Landlord Phone*

Current Rent*

Reason For Leaving*

Previous Residence

Previous Address

Previous City

Previous State

Previous Zip

Move In Date

Move Out Date

Previous Landlord

Landlord Phone

Previous Rent

Reason For Leaving

Employment Information

Current Status *

Current Employer*

Hire Date*

Employer Address*

Employer Phone*

Position*

Supervisor*

Current Income*

Frequency of income *

Other Income

Are you an active military service member? *

Nearest Relative Not Living With You

Full Name

Phone

Address

City

State

Zip

Character Reference

Full Name

Phone

Address

City

State

Zip

Credit Reference

Bank/Credit Union*

Branch*

Pets

Do You Have Pets? *

If yes, list breed and weight of each

Additional Information

Have you ever been convicted of a felony? (If yes, explain)*

Have you ever been evicted? (If yes, explain)*

Do you have a criminal background? (If yes, explain)*

Emergency Contact Information

Contact Name*

Relationship*

Address*

Phone*

Please Read Carefully Before Submitting

I am applying to lease the above-described premises for the term specified and the conditions as set forth in an N.C.R. Lease. I agree to pay with this application a non-refundable application fee of $80 single, current or previous NY residents $160.00 & KY $90.00. $150 married couple, current or previous NY residents $310.00 & KY $170.00, occupants $60 each, current or previous NY residents $140.00 & KY $70.00 or $80 grantor/co-signer & current or previous NY residents $160.00 & KY $90.00 to cover credit report, rental reference, employment and income verification. I agree to pay the entire first month’s rent in certified funds within 24 hours of acceptance. If I do not pay the first month’s rent within 24 hours, the property will not be held for me. I AUTHORIZE INTRACOASTAL REALTY TO ORDER MY CREDIT REPORT FOR THE PURPOSE OF REAL ESTATE RENTAL.

Please enter the characters in the image *

Application

Wilmington