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* Desired Property Adare Apartments, Nyack, NY Benner Apts., Highland Park, NJ Copper Ridge Apts., North Arlington, NJ Fair Haven Self Storage, Fair Haven, NJ Glenmare Apartments, Nyack, NY Grey Friars, Chaflont, PA Highland Terrace, Highland Park, NJ Liberty Square Apartments, Hatfield, PA Lincoln Gardens, Edison, NJ Martha Washington Apts., Clifton, NJ Monmouth Park Apts., Long Branch, NJ Oakhill Apts., Long Branch, NJ Park West Gardens, East Rutherford, NJ Park West Terrace, East Rutherford, NJ Princeton Lakeview Apts., Princeton, NJ Prospect Terrace Apts., Long Branch, NJ Raritan Landing Apts., Highland Park, NJ River Cross Apts., Bogota, NJ Seacrest Apts., Bradley Beach, NJ South Monmouth Beach Apts./Atlantic Ave., Long Branch, NJ Swan Court Apts., Rochelle Park, NJ Unit

Personal Information

* First Name * Last Name Home Phone * Cell Phone * Date of Birth * SSN Driver's License Number Driver's License State
* Email

Current Residence

* Current Address * City * State * Zip * How Long At This Address? Rent Reason For Moving? Owner / Manager Previous Owner Phone

Previous Residence

Previous Address Previous City Previous State Previous Zip How Long At This Address? Previous Rent Reason For Moving? Previous Owner / Manager Owner Phone

Other Occupants

Name and relationship of every person to live with you, even if only temporarily (include ages of minors):

Occupant 1

First Name Last Name Age Relationship

Occupant 2

First Name Last Name Age Relationship

Occupant 3

First Name Last Name Age Relationship

Occupant 4

First Name Last Name Age Relationship

Employment

* Occupation * Employer * How Long With This Employer? * Supervisor * Employer Phone * Current Gross Income * Hour, Month or Year * Other Income * Savings Account Bank * Checking Account Bank

Vehicle Information

Vehicle Make Vehicle Model Vehicle Year License Plate

Personal References

Reference 1

First Name Last Name Phone Relationship

Reference 2

First Name Last Name Phone Relationship

Emergency Contact

First Name Last Name Phone Relationship

Additional Information

Pets

Do You Have Pets? Please Select Yes No Pet Type Pet Breed Pet Weight
Ever Filed Bankruptcy? Please Select Yes No Ever Had an Eviction Filing? Please Select Yes No If Yes to any above, please explain:

How Did You Hear About Us?

* Select Source -- Friend/Family (word of mouth) Drive By (Property Sign) REGA.net (Web Search) Apartments.com Craigslist.com Rent.com Zillow.com Other * List Other Source

* I declare that the statements above are true and correct. I authorize verifications of my references and credit as they relate to my tenancy and to future rent collections. * The application fee is non-refundable. Please confirm availability with the office before applying. You can confirm this by contacting the REGA management office @ +1.732.930.5000 ext 211 or via email at rent@rega.net. * Type the letters shown