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COOPER REAL ESTATE MGMT LLC Rental Application

78 John Miller Way Suite 326
Kearny NJ 07032
O : 973-624-3300

Section 1: Property Applied For

Property Address

Unit Number

Desired Move-in Date

Rent Amount

Section 2: Applicant Information

Full Legal Name

Date of Birth

Phone Number

Email Address

Current Address

Previous Address 1

Previous Address 2

Social Security Number

Driver’s License/State ID Number

Issuing State

Section 3: Occupants

How many people will live in the unit?

Names of all adults

Names and ages of minors

Pets

Vehicles

Section 4: Housing History

Current Address

Current Landlord Name

Landlord Phone

Landlord Email

Current Rent Amount

Move-in Date at Current Address

Reason for Moving

Previous Landlord 1 Name

Previous Landlord 1 Phone

Previous Landlord 1 Email

Previous Landlord 2 Name

Previous Landlord 2 Phone

Previous Landlord 2 Email

Section 5: Employment and Income

Employer Name

Job Title

Supervisor/HR Contact Name

Employer Phone

Employer Email

Length of Employment

Gross Monthly Income

Pay Frequency

Other Income or Rental Assistance?

Section 6: Required Uploads

Government-issued Photo ID

Last 3 months worth of paystubs

Additional Proof of Income

Section 7: References

Personal Reference

Emergency Contact

Section 8: Authorization and Certification

I authorize Cooper Real Estate Management and/or the property owner to verify my rental history, employment, income, identity, references, and other information needed to evaluate this application.

I authorize Cooper Real Estate Management and/or the property owner to verify my rental history, employment, income, identity, references, and other information needed to evaluate this application.

I certify that all information provided is true, accurate, and complete.

I certify that all information provided is true, accurate, and complete.

I understand this application is not a lease and does not create a tenancy unless approved and a lease is signed.

I understand this application is not a lease and does not create a tenancy unless approved and a lease is signed.

Applicant Signature

Sign here

Section 9: Fair Housing Statement

Cooper Real Estate Management follows fair housing laws and does not discriminate based on race, color, religion, sex, national origin, disability, familial status, lawful source of income, sexual orientation, gender identity, marital status, or any other protected class under applicable law.