Tenant Application

For inquiries about the property, please contact ImThePreneur® , at

Email: Admin@imthepreneur.com

Phone: (203) 479-0889

Rental Property

Rental Property Address: 31 Hawthorne Ave, Derby CT 06418

Date of Availability: December 1, 2025

Type of Lease Term: Year-to-Year

Monthly Rental Payment: $2,000.00

Initial Security Deposit: $2000.00

Application Fee: $30.00

Rental Property

Applicants Personal Information

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Full Name *

First

Last

Applicants Email *

Phone Number *

(000)000-0000

Date of Birth

00/00/0000

Social Security Number *

000-00-0000

Desired Move-in Date

00/00/0000

CO-APPLICANTS PERSONAL INFORMATION

Name

First

Last

Phone Number

(000)000-0000

Date of Birth

00/00/0000

Social Security Number

000-00-0000

OTHER OCCUPANTS INFORMATION

Name

First

Last

Relationship to Applicant

Date of Birth

00/00/0000

Name

First

Last

Relationship to Applicant

Date of Birth

00/00/0000

RENTAL HISTORY

Current Address *

How long have you been residing at this address? *

Monthly Rent *

Landlords Name *

First

Last

Landlords Contact Number *

Reasons for leaving the property *

Have you ever been evicted? *

Have you missed two or more rental payments in the past 12 months? *

Have you ever refused to pay rent when due? *

If you answered YES to any of the above, please state your reasons and/or circumstances.

CURRENT EMPLOYMENT *

Employment Status *

Full-Time
Part-Time
Student
Unemployed
Retired

Current Employer *

Supervisor's Name *

First

Last

Phone *

Job Title *

Date Hired *

00/00/0000

Monthly Income *

Period of Employment

Selected Value: 0

(Select 1 if employed less than 1 year)

Other Sources of Income

comment 12 criminal

Proof of Income *

All documentation can be sent to Admin@Imthepreneur.com. (See confirmation page for details) If you have any questions or concerns, feel free to contact the property manager at (203) 479-0889.

Do you consent to a background/credit check? *

Is there anything that we may find in our credit check that you want to comment on? *

Do you consent to a criminal check? *

Is there anything that we may find in our criminal check that you want to comment on? *

Will you bring any pets? *

Dog
Cat
Other
None

*All cats and dogs are subject to a $150.00 one-time pet deposit.*

Will you bring a vehicle? *

I declare that the information I have provided is true and correct, and contains no misrepresentations. If misrepresentations are found after a residential lease agreement is entered into between the Landlord and Applicant, the Landlord shall have the option to terminate the residential lease agreement and seek all available remedies. Sign to acknowledge. *

First

Last

The Applicant authorizes the Landlord to verify all references and facts, including but not limited to current and previous landlords, employers and personal references. The Applicant understands that incomplete or incorrect information provided in the application may cause a delay in processing or may result in the denial of the application. Sign to acknowledge. *

First

Last

Co-applicants signature (if applicable)

First

Last

Application Fee

Price: $30.00

Enter Payment Information *