Our Brooklyn Realty

Name:
Address:
Date of Birth:
Phone:
Employer:
Occupation:
Annual Salary:
Social Security No.
Present Landlord:
Landlord's Phone No.
Reason for Moving:
Driver's License No.
Number of People Who Will Be Residing in Apt.
Pets?	Yes No
Reference One:
Reference Two:
I hereby direct Our Island Real Estate to obtain a copy of my credit report. This consent shall automatically expire (30) days from the date of the submission of this form. I agree to pay Our Island Real Estate one (1) month's rent, in consideration for service rendered in locating and securing the rental of an apartment. In the event that an apartment is not found, I will not be obligated to Our Island Real Estate. I further understand that, in addition, the Landlord may require one month's security and one month's rent when an agreement is reached. It is also understood a credit check may be required to verify my credit. This form will be photocopied and given to the landlord. Landlord's approval will be final determination.