Residential Rental Application

Each adult applying to be a leaseholder should complete a separate application. List other proposed occupants below. Complete applicable fields; use N/A where appropriate.

Proposed Rental

Applicant Information

Rental / Housing History

Income / Resources For Rent

Employment is not the only acceptable source of income. Provide information about lawful income or resources you want considered, including self-employment, benefits, pensions or rental assistance. Do not disclose medical diagnoses.

References & Optional Guarantor

Any guarantor application and guaranty agreement will be handled separately. Naming a proposed guarantor does not create a guaranty.

Supporting Document Checklist

Check documents available upon request. Provide only the records relevant to the income or resources being considered. Alternative documentation may be used.

Application & Screening Information

This application is for residential rental consideration only. It does not reserve the property, guarantee approval or create a lease. Any tenancy is subject to the applicable approval process and a separately executed lease.

No application-processing fee is imposed by this form. Any legally permitted screening charge must be disclosed separately before it is incurred and comply with applicable cost limits, report-delivery requirements and fee-waiver rules. This form does not authorize a holding deposit, credit-card surcharge or nonrefundable payment.

Any credit or consumer-report screening will use a separate disclosure and authorization process. This application does not request criminal history or authorize a criminal background check. Any such screening, if permitted and undertaken, must follow applicable notice, timing and review requirements.

Equal Housing Opportunity

Your Space New York provides equal housing opportunity. Applications are considered without unlawful discrimination, including discrimination based on lawful source of income. Reasonable accommodations may be requested by contacting the broker. Do not include medical information on this form.

Applicant Certification & Limited Authorization

I certify that the information I provided is accurate and complete to the best of my knowledge. I authorize Your Space New York LLC and the prospective landlord or managing agent to contact the housing, income and personal references I listed solely to verify information relevant to this rental application. This authorization does not authorize access to bank accounts, medical records or consumer reports.

I understand that additional relevant documentation may be requested. I may provide explanations or corrections. Signing this application does not waive any rights under applicable law.

Submit the information above using the button below. Arrange secure delivery of supporting documents with Craig Stulberger. Do not enter Social Security numbers, dates of birth, full bank account numbers or medical information. This form does not collect payments.