Rental Application

We require a completed rental application for each potential renter over the age of 18.

The applications must be processed before any property viewing, and there is no cost for submission.

Personal references cannot be a family member.

We offer an online application or you can choose to print the PDF file below and mail it to us:

LJH Management
660 Marbletown Rd.
Newark, NY 14513

Rental Application Form - Printable (PDF; 222KB)

Online Rental Application

Notice: All adult applicants (18 years or older) must complete a separate application for rental consideration.

Interest
Number of Bedrooms?	Desired Start Date
Property of Interest (Address)

Personal Information
First Name	Last Name
Date of Birth	Social Security #
Primary Phone	Secondary Phone
Email
Driver's License	State Issued

Is there a Co-applicant? Yes No
Co-applicant First Name	Co-applicant Last Name

Emergency Contact
First Name	Last Name
Address	Address cont.
City	State	Zip
Phone	Relationship

Emergency Contact #2
First Name	Last Name
Address	Address cont.
City	State	Zip
Phone	Relationship

Occupants
List all persons that will occupy the unit
First Name	Last Name
Age	Relationship

First Name	Last Name
Age	Relationship

First Name	Last Name
Age	Relationship

First Name	Last Name
Age	Relationship

Current Residence
Address	Address cont.
City	State	Zip
Landlord Name	Landlord Phone
Move In Date	Monthly Payment
Reason for Leaving

Previous Residence
Address	Address cont.
City	State	Zip
Landlord Name	Landlord Phone
Move In Date	Move Out Date
Monthly Payment
Reason for Leaving

Employment
Employer Name	Occupation
Supervisor Name	Phone
Start Date	Monthly Income

Employer #2 or Previous Employer
Employer Name	Occupation
Supervisor Name	Phone
Start Date	Monthly Income

Additional Income
Source (child support, military benefits, etc.)	Monthly Amount

Receive Gov. Assistance? (e.g. SEC. 8, SSI, DDS, etc.) Yes No	Agency Name
Caseworker Name	Caseworker Phone
If Yes, please explain including amount received per mn.

Vehicle(s)
Make	Model
Year	Color
License Plate	State Issued
Payments? Yes No	Monthly Payment Amount

Vehicle #2
Make	Model
Year	Color
License Plate	State Issued
Payments? Yes No	Monthly Payment Amount

Pets
Pet(s)? Yes No	Breed(s)
Type of Pet(s)	Age(s)
Please Note: We do not accept any pets over 20 pounds.	Weight(s)

Smoking
Does anyone in the household smoke? Yes No

Background
Have you (or any person named on this application) ever been sued for rent? Yes No
Have you (or any person named on this application) ever been evicted? Yes No
Have you (or any person named on this application) ever been sued for damages? Yes No
Have you (or any person named on this application) ever broken a lease? Yes No
Have you (or any person you have named on this application) ever declared bankruptcy? Yes No
If Yes to any above, please explain.

Personal References
First Name	Last Name
Address	Address cont.
City	State	Zip
Phone	Relationship

First Name	Last Name
Address	Address cont.
City	State	Zip
Phone	Relationship

Other
How did you hear about this property?
Please include any comments or info you believe would help to evaluate this application.

Agreement & Authorization (Please read carefully)
BY MY SIGNATURE BELOW I AUTHORIZE Scott Hartman, LJH Holdings, LLC and its agents to obtain an Investigative Consumer Credit Report including but not limited to credit history, landlord/tenant court record search, criminal record search and registered sex offender search. This authorization is valid for purposes of verifying information given pursuant to employment, leasing, rental, business negotiations, or any other lawful purpose covered under the Fair Credit Reporting Act (FCRA). BY MY SIGNATURE BELOW I AUTHORIZE the release of information from previous or current landlords, employers, and bank representatives. This investigation if for resident screening purposed only and is strictly confidential. This report contains information compiled from sources believed to be reliable, but the accuracy of which cannot be guaranteed. I hereby hold Scott Hartman and LJH Holdings LLC, Landlord and its agents free and harmless of any liability for any damages arising out of improper use of this information. This authorization shall be valid in original or copy form.
Signature	Date

Providing Rentals in Wayne & Ontario Counties of Western New York

Rental Application

Online Rental Application

Notice: All adult applicants (18 years or older) must complete a separate application for rental consideration.