Address You Are Applying For* Street Address* City* State* ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWYAEAAAP Zip* Move in Date* Are you working with a Realtor?* YESNO If Yes, Please provide name and contact information: Applicants Name* Email* Phone* SOCIAL SECURITY NUMBER AUTHORIZATION Applicants Name* Applicants Address* Social Security Number* Birthdate* I agree that Broker(s), his/her agent(s) and/or employee(s) may provide my social security number to lenders, title agencies, credit reporting companies, or others as necessary for obtaining reports or information from a credit reporting agency, determining the existence of domestic liens, obtaining a criminal background report (for prospective tenants only), ordering a mortgage payoff or for purposes of satisfying requirements of the Patriot Act. CONSUMER UNDERSTANDS THAT BROKER HAS NO CONTROL OVER THE USE OF ANY INFORMATION AFTER IT IS DISCLOSED TO A THIRD PARTY. CONSUMER AGREES TO RELEASE AND HOLD BROKER HARMLESS FROM ANY AND ALL LIABILITY FOR ANY MISUSE OR SUBSEQUENT DISCLOSURE BY ANY THIRD PARTY OF THE INFORMATION OR REPORTS DISCLOSED BY BROKER PURSUANT TO THE TERMS OF THIS AUTHORIZATION. Consumer's signature serves as an acknowledgement of receipt of a copy of this authorization. CURRENT RESIDENCE If anything does not apply to you, enter N/A in the spaces. Present Address / ZIP CODE* Current Residence* RentOwnOther Landlord First Name* Landlord Last Name* Landlord Phone* Monthly Rent / Mortgage* From* To* PREVIOUS RESIDENCE If does not apply - write N/A Present Address / ZIP CODE* Current Residence* RentOwnOther Landlord First Name* Landlord Last Name* Landlord Phone* Monthly Rent / Mortgage* From* To* ADDITIONAL APPLICANTS Please add the names of each applicant applying with you. Are you applying with anyone else 18 years or older? * YESNO Applicants Name Applicants Name Applicants Name Applicants Name Applicants Name Will a dependent or anyone under the age of 18 be living with you? * YESNO Name Name Name Name Name EMPLOYMENT INFORMATION Provide at least three years of history. Attach additional files, if needed. Attach proof of income, copy of paystub, employer letter, etc. File Upload* File Upload File Upload File Upload File Upload File Upload Current Employer* If anything does not apply to you, write N/A in the spaces Supervisors First Name* Supervisors Last Name* Supervisors Phone* Position* Hours per week Hourly Rate Employed From* Employed To* Previous Employer* If anything does not apply to you, write N/A in the spaces Supervisors First Name* Supervisors Last Name* Supervisors Phone* Position* Hours per week Hourly Rate Employed From* Employed To* Previous Employer If anything does not apply to you, write N/A in the spaces Supervisors First Name Supervisors Last Name Supervisors Phone Position Hours per week Hourly Rate Employed From Employed To Previous Employer If anything does not apply to you, write N/A in the spaces Supervisors First Name Supervisors Last Name Supervisors Phone Position Hours per week Hourly Rate Employed From Employed To ADDITIONAL INCOME FOR MONTHLY EXPENSES If not applicable, write N/A Other Amount Other Amount Other Amount Other Amount BANK ACCOUNT INFORMATION Bank Name Balance Bank Name Balance Available funds (not in bank) MONTHLY PAYMENTS Additional monthly expenses Car Insurance Lender Name: Monthly Payment Balance Due Cell Phone Provider: Monthly Payment Balance Due Credit Card Lender Name: Monthly Payment Balance Due Personal Loan Personal Loan: Monthly Payment Balance Due Other payments Other payments VEHICLE Include any cars, trucks, vans, motorcycles, trailers, boats and recreational vehicles. Make/Model* Year* License Plate/State* Color* VEHICLE 2 Make/Model Year License Plate/State Color PETS Does any Applicant or Occupant own any pets? (Guide and support animals not included)* YESNO Type (cat, dog, etc.) / Breed / Age / Weight / Gender If you have a cat, is it declawed? YESNO OTHER INFORMATION Have you ever declared bankruptcy or suffered foreclosure?* YESNO Have you ever defaulted on your mortgage?* YESNO Have you been evicted or sued for unpaid rent or damages to leased property?* YESNO Have you ever refused to pay rent for any reason?* YESNO Have you ever been convicted of or entered a plea of guilty or nolo contendere for a felony or misdemeanor?* YESNO If answered "yes" to any of the above questions, please explain any answers below: (If not applicable, write N/A)* Since January 1, 1998, Have you been obligated to pay support under any order(s) or record?* YESNO If "yes" County Domestic Relations File or Docket Number: Amount: Are you delinquent? CONDITION OF PROPERTY The Property will be leased in the same condition as it is shown unless otherwise provided in the lease. APPLICATION FEE The Application Fee is NON-REFUNDABLE and will not be applied towards rent or other financial obligations should Applicant be approved, nor refunded if not approved. Applicant agrees that this sum is paid in consideration of Landlord/Broker for Landlord's review and/or verification of the information stated in the application. OBLIGATION TO ENTER INTO LEASE AGREEMENT/DAMAGES Upon submission of this Application, Landlord/Broker for Landlord reserves the right to remove property from the available rent list. If this application is denied by Landlord, the Application Deposit shall be refunded to Applicant. If this Application is approved and Applicant fails to rent the Property, Landlord shall be entitled to retain the Application Deposit. CONVICTED SEX OFFENDERS (MEGAN'S LAW) The Pennsylvania General Assembly has passed legislation (often referred to as "Megan's Law", 42 Pa.C.S. |9791 et seq.) providing for community notification of the presence of certain convicted sex offenders. Potential tenants are encouraged to contact the municipal police department or the Pennsylvania State Police for information relating to the presence of sex offenders near a particular property, or to check the information on the Pennsylvania State Police website at www.pameganslaw.state.pa.us NOTICE TO PERSONS OFFERING TO SELL OR RENT HOUSING IN PENNSYLVANIA (A) Federal and state laws make it illegal for Landlord, Broker, or anyone to use RACE, COLOR, RELIGION or RELIGIOUS CREED, SEX, DISABILITY (physical or mental), FAMILIAL STATUS (children under 18 years of age), AGE (40 or older), NATIONAL ORIGIN, USE OR HANDLING/TRAINING OR SUPPORT OR GUIDE ANIMALS, or the FACT OR RELATIONSHIP OR ASSOCIATION TO AN INDIVIDUAL KNOWN TO HAVE A DISABILITY as it reasons for refusing to sell, show, or rent properties, loan money, or set deposit amount, or as reasons for any decision relating to the sale of property. The municipality in which the property is located may have enacted an ordinance or other law that extends the protections for access to housing to additional classes of individuals, such as gay, lesbian, bisexual and transgender individuals and couples. Broker and Landlord are advised to check with your local municipality, representative from Pennsylvania Human Relations Commission, or your own attorney for further guidance. (B) The Fair Housing Act prohibits rental practices which have a discriminatory effect on members of protected classes, including outright bans on offering housing to individuals based on arrests or convictions without a case-by-case assessment of relevant mitigating factors. Consideration of an applicant's criminal history must be limited to convictions and should include an evaluation of the nature and severity of the offense, the amount of time that has passed since the criminal conduct occurred, and whether denial of the application will serve a substantial, legitimate, nondiscriminatory interest. Selective use of an applicant's criminal history as a pretext for intentional discrimination based on race, national origin, or other protected characteristics may be a violation of the Act, as well. SPECIAL CLAUSES If the Landlord or Broker denies your application based in whole or in part on any information contained in the consumer report authorized by paragraph 16 of this Application, the Landlord or Broker must provide you with oral, written or electronic notice of the denial, and must provide to you: (1) the name, address, and telephone number of the consumer reporting agency (including a toll-free telephone number established by agency if the agency complies and maintains files on consumers on a nationwide basis) that furnished the report, (2) a statement that the consumer reporting agency did not make the decision to deny the application and is unable to provide you with specific reasons why your application was denied, (3) a numerical credit score, the range of possible credit scores under the model used, up to four key factors that led to the denial, and the date the credit score was created (4) information about how to obtain a free copy of your consumer report from the consumer reporting agency, and (5) information about how to dispute the accuracy or completeness of any information in a consumer report furnished by the agency. If the Landlord or Broker denies your application because of information from a person other than a credit reporting agency (for example, an employer or prior landlord), the Landlord or Broker must provide you with notice about your right to make a written request to discover the nature of that information. FAIR CREDIT REPORTING ACT A description of the section goes here. AUTHORIZATION By checking the boxes below, Applicant makes the following authorization: Applicant authorizes Landlord or Broker for Landlord to obtain any information deemed necessary to evaluate this Application. This information may include, but is not limited to, credit reports, criminal history, judgements or record, rental history, verification of employment and salary, employment history, vehicle records, and licensing records. Broker for Landlord may report to Landlord any information obtained by Broker for Landlord for evaluation of the Application. Applicant acknowledges that all information in the Application is true and correct. Applicant acknowledges that if applicant presents false or incomplete information Landlord may reject this Application. Applicant understands that giving false or incomplete information may result in forfeiture of any payments made in connection with this Rental Application.* yes Applicant understands and acknowledges that Applicant's social security number, driver's license number, date of birth, or other personal identifying information may be required in order for Landlord or Broker for Landlord to evaluate this application. If requested, Applicant agrees to provide the information on a separate form such as the Social Security Number Authorization (PAR Form SSA). Failure to provide this information may result in denial of your Application.* yes Applicant agrees that Broker(s), his/her agent(s) and/or employee(s) may provide Applicant's social security number, individual taxpayer identification number, driver's license information and date of birth to lenders, title agencies, credit reporting companies, or others as necessary for obtaining reports or information from a credit reporting agency, determining the existence of domestic liens, or for obtaining a criminal background report (for prospective tenants only). Applicant understands that Brokers have no control over the use of any information after it is disclosed to a third party and agrees to release and hold Brokers harmless from any and all liability for any misuse or subsequent disclosure by any third party of the information or reports disclosed by Broker pursuant to the terms of this authorization.* yes Applicant authorizes the Broker for Landlord to contact the Applicant directly.* yes I HAVE READ AND AGREE TO THE PROVISIONS AS STATED* yes Additional information you would like us to consider while reviewing application N/A if not applicable If this application is approved and a deposit is collected, and applicant fails to rent property - landlord shall be entitled to obtain deposit monies as damages.* yes By checking the box below, I agree to pay the application fee of $60 per applicant 18 years or older.* yes Signature* Date Signed* 351 total views, 2 views today
