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Please complete the Preliminary Rental Application form below:
All fields are required.

Application Date:
Applicant: Co-Applicant
First Name: First Name:
Initial: Initial: 
Last Name: Last Name:
Birth: Birth:
Home Phone: Home Phone:
Message/Business Phone: Message/Business Phone:

Income : Estimate Yearly figures are acceptable for this preliminary Application

Employment: Employment:
Pension: Pension:
Social Security: Social Security:
Disability: Disability:
Interest of Savings & Stock: Interest of Savings & Stock:
Type of Apartment: One Bedroom Two Bedroom Handicapped
Number of Residents: Over 18 years  Under 18 years
Please check category that applies to you: 
Caucasian  Black    Asian   American Indian   Hispanic   Other:

The New Jersey Law Against Discrimination, N.J.S.A. 10:5-1 to –49, makes it unlawful to discriminate in the sale or rental of housing based on a person’s race, creed, color, national origin, ancestry, nationality, affectional or sexual orientation, disability, gender, marital status, familial status (whether you have a
child, a parent-child relationship with a minor, or you are pregnant), lawful source of income or rental subsidy used for rental payments.

The New Jersey Division on Civil Rights is the State agency that is authorized to enforce the Law Against Discrimination. Under the Division’s Multiple Dwelling Reporting Rules, N.J.A.C. 13:10-1.1 to -2.6, the Division requires landlords to collect and record information about applicants for apartment rentals and tenants in apartment complexes throughout New Jersey. The Multiple Dwelling Reporting Rule requires landlords to provide a summary of this information to the Division and to retain the information on this form. The information is used to prevent and eliminate discrimination in housing. Your cooperation in filling out this form will assist the Division in enforcing the Law Against Discrimination.

Please note that, although landlords must record certain information about the race and ethnicity of applicants and tenants, it is unlawful to record or ask applicants or tenants about other characteristics such as religion, gender, marital status or affectional or sexual orientation. If you feel you have been denied housing or treated differently for one of the reasons listed above, you may contact the Division on Civil Rights at (609) 984-3138 for referral to a local Division office for additional information or assistance.

Download the Multiple Dwelling Reporting Rule Tenant/Application Inquiry in pdf



Vermont Plaza Apartments • 130 South Vermont Ave. • Atlantic City, NJ 08401 • (609) 348-6477
Managed by Sencit Properties Inc