APPLICATION FOR APARTMENT RENTAL

I hereby apply for rental of an apartment and give the following information to induce the owner to rent the apartment
to me:

1. Applicant's Name ________________________________________________________________________

2. Present Address __________________________________________________________________________

3. Number of rooms needed __________________________________________________________________

4. Telephone # Home: ______________________________________________________________________

Work: _______________________________________________________________________

5. References: a. ___________________________________________________________________________

b. __________________________________________________________________________

c. __________________________________________________________________________

If this application is accepted by the owner of a unit, introduced to me by Norman Ostrow, Inc., I agree to pay Norman
Ostrow, Inc. a rental fee equal to one month's rent.

TODAY'S DATE _______________________

_____________________________________
Applicant's Signature:
_____________________________________
Applicant's Social Security Number
(APPLICATION CANNOT BE PROCESSED
WITHOUT SOCIAL SECURITY #)

DO NOT WRITE BELOW THIS LINE

RENT ________________________

SECURITY ________________________

AGENCY FEE ________________________

TOTAL ________________________ (Amount needed to move into apartment)

DEPOSIT ________________________ (Must equal one month's rent)

BALANCE DUE_______________________(Must be paid by __________________)

Applicant's Name __________________________________________________________________________________________________

Present Address ___________________________________________________________________________________________________

How long at present address? _______________________________ Present Rent _______________________________________________

Present Landlord _________________________________Address __________________________________________________________

Employer _______________________________________ Address __________________________________________________________

Length of Service ________________________ Salary ___________________ Telephone # ______________________________________

Spouse Employer _________________________________ Address _________________________________________________________

Length of Service _________________________ Salary ___________________ Position ________________________________________

No. in family: Adults ___________Children __________ Children's Ages _____________________________________________________

Name of Bank __________________________ Address _____________________ __________________Acct. # _____________________

References: _______________________________________________________________________________________________________
Name Address Tel. #
______________________________________________________________________________________________________
Name Address Tel. #

DO NOT WRITE BELOW THIS LINE

I hereby agree to rent Apt. #__________ at ______________________________________________

from ___________________ at a monthly rent of $_____________ due and payable the first day of
each month, and I hereby agree to the following conditions:
1. This month to month lease is subject to the owner's approval, and if declined by the owner, the deposit is to
be refunded.
2. I understand and agree that the deposit I am giving on this apartment will not be refunded to me if I change
my mind about taking the apartment. I further agree that if I do not pay the balance of the deposit and one
month's security by the date that I have rented the apartment from, I will forfeit my deposit and hereby give
the agent permission to re-rent the apartment to someone else.
3. I further understand and agree that my security is not to be refunded to me for the following reasons:
a. If I do not give one month's written notice to vacate prior to the day on which the last month's rent is
due.
b. If I do not remove all my furniture and do not leave the apartment in good condition, except for
reasonable wear and tear.
c. If I do not show my apartment to prospective tenants during reasonable hours.
4. I understand and agree to paint my apartment at my own expense. The paint is to be supplied by the
Landlord ___________ Tenant _____________.
5. I understand and agree not to install air conditioners or washing machines and will not have pets occupying
the apartment without the written consent of the agent or owner. I understand I must purchase apartment
insurance, in case of loss.
6. Rents received after the fifth day of the month will incur a late fee of $50.00. Rents received after the
eighth day of the month will owe an additional $53.00 fee for court costs incurred due to filing with the
Superior Court of New Jersey.
7. Security of $ __________________ is on deposit in Escrow Savings Account #066097809 at The Provident
Bank at a rate of _________%. Interest is to be paid to tenant by January 31st each year.
8. LEAD-BASED PAINT DOCUMENT ACKNOWLEDGMENT: (Applies to dwellings built before 1978)
The Tenant acknowledges receipt of the EPA pamphlet, “Protect Your Family From Lead In Your Home”.
Moreover, a copy of the document entitled, “Disclosure of Information on Lead-Based Paint and Lead-
Based Paint Hazards” has been fully completed, signed by Tenant, Landlord and Broker(s) and is appended
to and made a part of this Agreement.
9. WINDOW GUARD NOTIFICATION:
IN THE EVENT TENANT RESIDES IN A MULTIPLE DWELLING IN AN APARTMENT UNIT
ABOVE THE FIRST FLOOR (AS DEFINED BELOW), AND THE UNIT IS OCCUPIED BY A CHILD
OR CHILDREN 10 YEARS OF AGE OR UNDER, OR A CHILD OR CHILDREN 10 YEARS OF AGE
OR UNDER ARE REGULARLY PRESENT FOR A SUBSTANTIAL PERIOD OF TIME IN THE UNIT
AS AND TO THE EXTENT PROVIDED IN N.J.S.A. 55:13A-7.12 AND/OR N.J.A.C. 5:10-27, TENANT
MAY REQUIRE OWNER, LESSOR OR THE AGENT OR OTHER PERSON WHO MANAGES THE
MULTIPLE DWELLING TO FURNISH, INSTALL AND MAINTAIN APPROVED CHILD
PROTECTION WINDOW GUARDS ON WINDOWS IN SUCH UNIT AND ON ANY WINDOWS IN
THE PUBLIC HALLWAYS TO WHICH SUCH CHILD OR CHILDREN HAVE ACCESS WITHOUT
HAVING TO GO OUT OF THE BUILDING BY MAKING A WRITTEN REQUEST FOR SUCH
WINDOW GUARDS TO THE OWNER, LESSOR OR AGENT OR OTHER PERSON WHO MANAGES
OR CONTROLS THE MULTIPLE DWELLING.

THIS LAW DOES NOT APPLY TO (1) ANY WINDOW THAT (a) GIVES ACCESS TO A FIRE
ESCAPE, (b) IS NOT DESIGNED TO OPEN, OR (c) IS ON THE FIRST FLOOR, EXCEPT IN SUCH
CIRCUMSTANCES AS THE COMMISSIONER MAY PROVIDE BY RULE OR (2) SEASONAL
RENTAL UNITS, WHICH INCLUDE DWELLING UNITS RENTED FOR A TERM OF NOT MORE
THAN 125 CONSECUTIVE DAYS FOR RESIDENTIAL PURPOSES BY A PERSON HAVING A
PERMANENT RESIDENCE ELSEWHERE BUT SHALL NOT INCLUDE USE OR RENTAL OF
LIVING QUARTERS BY MIGRANT, TEMPORARY OR SEASONAL WORKERS IN CONNECTION
WITH ANY WORK OR PLACE WHERE WORK IS BEING PERFORMED. A WINDOW IN A ROOM
OR HALLWAY SHALL NOT BE CONSIDERED TO BE ON THE FIRST FLOOR IF THE FINISHED
SURFACE OF THE FLOOR OF THAT ROOM OR HALLWAY IS MORE THAN SIX FEET ABOVE
GRADE AS MEASURED AT THE LOCATION OF THE WINDOW. IN THE EVENT TENANT
RESIDES IN AN APARTMENT UNIT ON THE FIRST FLOOR AND SUCH UNIT WILL ALSO BE
OCCUPIED BY A CHILD OR CHILDREN 10 YEARS OF AGE OR UNDER, OR A CHILD OR
CHILDREN 10 YEARS OF AGE OR UNDER ARE REGULARLY PRESENT FOR A SUBSTANTIAL
PERIOD OF TIME IN THE UNIT AS AND TO THE EXTENT PROVIDED IN N.J.S.A. 55:13A-7.12
AND/OR N.J.A.C. 5:10-27, TENANT MAY HAVE CHILD PROTECTION WINDOW GUARDS
INSTALLED IN THE PUBLIC HALLWAYS ABOVE THE FIRST FLOOR TO WHICH SUCH CHILD
OR CHILDREN HAVE ACCESS WITHOUT HAVING TO GO OUT OF THE BUILDING BY MAKING
A WRITTEN REQUEST FOR SUCH WINDOW GUARDS TO THE OWNER, LESSOR OR AGENT OR
OTHER PERSON WHO MANAGES OR CONTROLS THE DWELLING. NOTWITHSTANDING ANY
MUNICIPAL ORDINANCE TO THE CONTRARY, EXPENDITURES MADE PURSUANT TO N.J.S.A
55:13A-7.13 SHALL BE DEEMED TO BE CAPITAL IMPROVEMENT COSTS, WHICH MAY BE
PASSED ON TO THE TENANTS OF THE MULTIPLE DWELLING.

10. MEGAN’S LAW STATEMENT:

UNDER NEW JERSEY LAW, THE COUNTY PROSECUTOR DETERMINES WHETHER AND HOW
TO PROVIDE NOTICE OF THE PRESENCE OF CONVICTED SEX OFFENDERS IN AN AREA. IN
THEIR PROFESSIONAL CAPACITY, REAL ESTATE LICENSEES ARE NOT ENTITLED TO
 NOTIFICATION BY THE COUNTY PROSECUTOR UNDER MEGAN’S LAW AND ARE UNABLE
TO OBTAIN SUCH INFORMATION FOR YOU. UPON CLOSING, THE COUNTY PROSECUTOR
MAY BE CONTACTED FOR SUCH FURTHER INFORMATION AS MAY BE DISCLOSABLE TO
YOU.

11. PREMISES CANNOT BE SUBLET WITHOUT WRITTEN CONSENT OF LANDLORD & AGENT.

_____________________________________ __________________________________________
Renting Agent Date Tenant Date

_________________________________________
Tenant Date

ACKNOWLEDGMENT: by signing below I am indicating that I have received copies of the following: 1. The EPA
approved pamphlet “Protect Your Family From Lead In Your Home”, 2. The Window Guard Notification and
3. “Rental Statement” – a signed copy of the Rental Statement including name and address of Owner; name, address
and phone number of Superintendent; a 24-hour emergency phone number; description of the rental space and related
services; the base rent as of the date of inception of the tenancy as well as the prior tenant’s base rent; and notification
of the existence of the rent registration law. 4. A copy of the booklet “Truth in Renting”.

Tenant acknowledges receipt of copy of this agreement

_______________________________________________________
Tenant Signature Date