LeGo.org                                                  

    LESTER  GOLDSTEIN                                    4226   CHESTER   AVENUE          PHILADELPHIA,  PA  19104                            ph/fax   215- 382-1085

President, LeGo Management                                                                                                                                                                   e-mail: apartments@LeGo.org        

                                                                                                                                       

 

NAME: _____________________________________________________           SOC. SEC. #  ______-____ -________

TEL home: _____-______-__________  work: _____-______-__________    e-mail: _____________________________

Drivers License:  State: ____   Operator # _________________________      Birthday:  month _____   day  _____

ADDRESS (complete present): ______________________________________________________     ZIP:____________

      From:  ______/______        to: ______/______                      RENT:  $ _____________  /mo (Your amount if shared)

      Landlord: _________________________________________________     Tele. _____-______-__________

      Reason  for leaving: _____________________________________________________________________  

ADDRESS (complete prior): _________________________________________________________   ZIP:____________       

    From:  ______/______        to: ______/______                      RENT:  $ _____________  /mo

     Landlord: _________________________________________________     Tele. _____-______-__________

     Reason  for leaving: _____________________________________________________________________

EDUCATION:  Institution ____________________________________   Years  Completed ___  or Year of  Grad. ______ 

Employer: _____________________________________________________           starting date (mm/yr):  ____/____  

      position: ________________________________________          full time __      part time __  (hours/wk _____)

      Supervisor's name: ____________________________________      Tele.    _____-______-__________

      Weekly take home pay (in hundreds):    less than 2         2-3           4-5           6-8           9-12           13-15             >15 

total monthly debt  payments:  $ ____________  (use back of page for explanation)

BANK OR CREDIT REFERENCES:               TYPE OF ACCOUNT                  OPENED             ACCOUNT  #  (last 4 digits only if cc)

    ________________________________      _________________          __________        ________________________

    ________________________________      _________________          __________        ________________________

CREDIt REPORT:  Are there adverse listings on your credit report:  Yes ___            No ____           Don’t know _____

      (If  “yes,”  explain on back of page) 

                

NAME AND RELATIONSHIP  of any person(s)  who will be living with you FULL OR PART TIME.     

      Write "none"  if none.  Name(s):____________________________________________________________________  

                  relationship: ___________________________         AGES  (if  less than 18 years old): __________________________

PETS:  (No)     (Yes)  Description:______________________________________________________________________

NONSMOKER:   YES ___     NOTE:  ALL  areas of the  premises and grounds are  STRICTLY  NONSMOKING! 

LIST ALL NOISY OR POTENTIALLY DISTURBING ACTIVITIES (i.e.,  dancing, playing musical instrument, etc.)                                                                                                      ________________________________________________________________________  (Write "none"   if none):   

landlord/tenant dispute:  Are you presently or  have you been in a dispute with a landlord that involved  an   

       arbitrator a court or other third party intervention:  YES ___     NO ___

 

EMERGENCY  NOTIFICATION: Name: ______________________________________  Relationship: ______________ 

      Address: ___________________________________________________________    Tele. _____-______-__________

 

        I affirm THAT THE ABOVE INFORMATION IS CORRECT AND COMPLETE .    I  ALSO agree to promptly  inform landlord should changes occur  IN

MY FINANCIAL CONDITION during my residency.     I UNDERSTAND THAT LANDLORD MAY  DENY OR  TERMINATE A LEASE FOR  material MISREPRESENTATION

OR  OMISSION and/or failure to promptly provide updated information upon request.

        I grant PERMISSION  TO LANDLORD TO  acquire and  VERiFY  INFORMATION  relevant to my tenancy.

 

    Signature:  _________________________________________     ___/___/___    Application Fee ($35.00): ______