FAX To: GenData LLC
48 Bi-State Plaza Suite 253, Old Tappan, NJ 07675
FAX: (201) 594-0370 Phone: (201) 594-0300

OWNER/MANAGEMENT CO__________________________________ SUBSCRIBER #______________
For Occupancy At_________________________________ APT______ Rent/Maint $________

Instructions for Applicant
Print all information clearly.  Include All Account and Phone Numbers.  Read, sign, and date application.

Personal Information

Name_________________________________________________ Birthdate_____/_____/_____
     First                     Middle            Last                  

Drivers Lic #___________________________ State_____ Soc Sec #______/____/_______

Residence Information

            Street                             City                     State     ZIP         Apt. No.
Rent/Maint $_________ Move In Date_______ Expire Date_______ Phone______________
                                                                                  Home Phone
Landlord____________________________________________________ Phone______________
           Company Name          Address           City          State    ZIP     Landlord Phone

Employment Information

Employer Name         Address                         City                        State     ZIP
Position____________________________ Annual Income $________ Phone______________
Supervisor________________________________ Start Date_______ Phone______________
Prev Employer___________________________________________ Annual Income $________
Position _________________ Start Date_______ End Date_______ Phone______________

Bank Information

Bank____________________________________________________ Avg Bal $______________
     Name                              City               State     ZIP
Account #_________________________ __Checking __Saving  Bank Phone______________
Bank Name_________________________ __Checking __Saving  Avg Bal $_______________
Account #__________________________                     Bank Phone______________

                                Name                     Phone Number             City               State

This credit report is subject to approval by the owner or agent and may be without cause disapproved by them.  I hereby authorize GenData LLC to use any consumer reporting agency, credit bureau, or investigative agency to confirm the information contained herein, pertaining to my employment history, credit history, prior tenancies, character, and to obtain a credit report and any other credit or criminal information, and to disclose such information to the owner/agent or representative in support of this application.  I have completed this application and recognize that the truth of the information contained herein is essential.

Applicant's Signature___________________________________________ Date___________

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