BASS RIVER PROPERTIES            $20.00 APPLICATION FEE IS REQUIRED FOR 1^ST APPLICANT

150 Main Street, Route 28               $10.00 PER 2^nd APPLICANT
West Dennis, MA  02670                                  $5.00     FOR ALL OTHER ALLPLICANTS  
(508) 394-4446- Phone                     $100.00 PROCESSING FEE IF ACCEPTED. APPLICATION FEE WILL BE

(508) 394-4819- Fax                        CREDITED TOWARD PROCESSING FEE IF ACCEPTED.

www.bassriverproperties.com            RENTAL  APPLICATION               DATE:-----------------------------                                                                                                                                                                                            Desired Location:_____________

                                                                Rental application only Subject to Owner approval and Acceptance                               

________________________________________________________________________________________________________________

Name of Applicant              Number of Dependents         Home Phone                     Date of Birth               Social Security #

Present Address            City               Zip            Length of Tenancy                           Number of cars           Registration#

Present Landlord                                 Complete Address                                           Phone Number            Reason for Leaving

Former Address # 1                            Former Landlord                                             Phone Number            Occupancy Years

Former Address # 2                             Former Landlord                                            Phone Number            Occupancy Years

________________________________________________________________________________________________________________

Current Employer                                Complete Address                                             Phone Number            Employment Start   Salary

________________________________________________________________________________________________________________

Former Employer                                 Complete Address                                            Phone Number            Length of Employment

Personal Reference (name)                  Complete Address                                          Phone Number             Occupation

In case of Emergency Notify                    Complete Address                                     Phone Number

Credit Reference                                       Complete Address                                      Phone Number

Bank Savings/Checking Acct        Branch Address                                       Account Number(s)

Names of All Co-Tenants (each adult must file separate application)                     Make of Vacuum cleaner

Apartment Number              Total number of Occupants      Number of Adults          Pet      Smoker   Non smoker   (circle one)

Address                Names and Ages of  Minor Children                                                                   Base Rent per Month $________________

                                                                                                                                                           Subject to escalation as

City                       Occupancy data                                        Rent begins                                        Other monthly charges $______________

Terms of Lease (months)                 From                              To                                                      (E.G. Parking, etc.)

Base Rent and Other Monthly Charges are due and payable on the first day of each month           Last Month’s Rent $_________________

                                                                                                                                                           Security Deposit $ _________________

                                                                                                                                                           Deposit on Account $_______________

Pursuant to Massachusetts Law, the Management shall not make any inquiry concerning the race, religious creed, color, national origin, sex, age (except if a minor,) ancestry or marital status of the applicant or concerning the fact that the applicant is a veteran, a member of the Armed Forces or is blind.

Neither the Owner nor the Management is responsible for the loss of personal belongings caused by fire, theft, smoke, water or otherwise, unless cause by their negligence. 

The undersign warrants and represents that all statements herein are true and agree to execute upon presentation a Rental Housing Association Lease or Tenancy at Will Agreement in the usual form, a copy of which the applicant has received or has had occasion to examine, which lease or agreement may be terminated by the Lessor if any statement herein made no true.  Deposit is to be applied as shown above, or applied to actual damages sustained by the owner, except it is to be refunded if said application is not accepted by the owner.  This application & deposit are taken subject to previous application.

The Renting Agent is an independent contractor and has no authority to make any representation concerning the premises.  Renting Agent is only authorized to show the apartment for rent. Landlord reserves right to discriminate against smokers and pets.

By signing this form the Applicant understands that a credit and reference check may be undertaken to determine rental history and ability to pay the rental amount.  The applicant hereby authorizes the references listed above to release credit and other appropriate information to landlord for his purpose. All information gathered by the landlord will remain confidential.