A J. E. Gibson Company
Call Us: 607-243-7568

Apartment Rental Agreement

Please fill out the following agreement. An * means a required field. You can print the form after you are done but PRIOR to pressing Submit. Once you press Submit, the form data will be cleared.

Apartment Information

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

Applicant information

  • List names and birth dates of ALL additional Occupants below

Employment and Income Information


Emergency Contacts


Background Information


Vehicle Information


Other Information

  • I/we, the undersigned, authorize On-Site.com, Landlord and its agents to obtain an investigative consumer credit report including but not limited to credit history, OFAC search, landlord/tenant court record search, criminal record search and registered sex offender search. I authorize the release of information from previous or current landlords, employers, and bank representatives. This investigation is for resident screening purposes only, and is strictly confidential. This report containts information compiled from sources believed to be reliable, but the accuracy of which cannot be guaranteed. I hereby hold On-Site.com, Landlord and its agents free and harmless of any liability for any damages arising out of any improper use of this information. Important information about your rights under the Fair Credit Reporting Act:
    • You have a right to request disclosure of the nature and scope of the investigation
    • You must be told if information in your file has been used against you
    • You have a right to know what is in your file, and this disclosure may be free
    • You have a right to ask for a credit score (there may be a fee for this service)
    • You have the right to dispute incomplete or inaccurate information. Consumer reporting agencies must correct inaccurate, incomplete, or unverifiable information.
    These reports are being processed by On-Site.com, P.O. Box 1514, Los Altos, CA 94023-1514, (877) 222-0384. A summary of your rights under the Fair Credit Reporting Act is available by visiting or writing (Para information en espanol, visite o escribe): http://www.ftc.gov/credit Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Avenue N.W. Washington, D.C. 20580



Residential • Commercial • Roll-Off Dumpster
Cardinal Disposal
635 Shannon Corners Road
P.O. Box 175 • Dundee, NY 14837