Application for Max Carballo Banos
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REAL ESTATE AND INSURANCE MANAGEMENT

Nassau 3025 Hempstead Tpk. Levittown NY 11756

Tel 516 303-3379  |  Email Mannyhomes1010@gmail.com

Rental Application

Primary Applicant
Max Carballo Banos
Name
2139652447
Phone
cooklove90@hotmail.com
Email
8/1/1990
Date of Birth
1051 Reilly St
Present Address
913-96-6653
Social Security #
Do you Smoke?
Do you have Pets?
$80000
Monthly Income $
Employment
TAQUERO MUCHO
Employer
$80000/mo
Present Salary
15 E DEER PARK RD DIX HILLS NY 11746
Address
Length of Employment
Position
Supervisor
Employer Phone #
Tenant 2 / Spouse
Patricia Abigail Gomez Escoto
Name
6312159613
Phone
cooklove90@hotmail.com
Email
10/28/1995
Date of Birth
Present Address
Social Security #
Do you Smoke?
Do you have Pets?
720
Credit Score
Employer
Present Salary
Address
Length of Employment
Position
Supervisor
Employer Phone #
Tenant 3
Name
Phone
Email
Date of Birth
Present Address
Social Security #
Do you Smoke?
Do you have Pets?
Credit Score
Employer
Present Salary
Address
Length of Employment
Position
Supervisor
Employer Phone #
Present Landlord
Present Landlord Name
Phone
Address
Zip
Current Rent $
How long a tenant?
Reason for moving
Tenant 2 Present Landlord
Landlord Name
Phone
Address
Zip
Current Rent $
How long a tenant?
Reason for moving
Tenant 3 Present Landlord
Landlord Name
Phone
Address
Zip
Current Rent $
How long a tenant?
Reason for moving
References
Name
Address / Phone
Name
Address / Phone
Name
Address / Phone
Children / Minor Occupants
Name
Age
Name
Age
Name
Age

I, the undersigned(s), acknowledge that I/We am/are responsible to pay REIIM a fee equal to one month's rent for brokerage services in locating and arranging for the rental of premises. It is understood that this non-negotiable fee is due and payable at lease execution (NO EXCEPTIONS).

No deposit is refundable unless otherwise specified in writing. The undersigned hereby agrees that no litigation will be made against REIIM and our agency assumes no responsibility for representing the legality of apartment(s) shown and/or accepted.

The undersigned does hereby authorize REIIM and/or its agent or employees permission to verify all the information contained in this application for the sole purpose of renting an apartment or house.

Tenant 1 Signature       Date

Tenant 2 Signature       Date

Tenant 3 Signature       Date

Please provide copies of the following:

  • Driver's license or government-issued photo ID
  • 2 most recent pay stubs
  • Most recent W2 and 1st page of tax returns
  • 1st page of Bank Statement
  • Copy of the most recent credit report(s) (if you don't have it, one can be pulled for you)
REIIM – Real Estate and Insurance Management  |  3025 Hempstead Tpk. Levittown NY 11756  |  Tel 516 303-3379