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/yy): ____/____
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 #
________________________________ _________________ __________ ________________________
________________________________ _________________ __________ ________________________
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): ______