Address You Are Applying For*

    SOCIAL SECURITY NUMBER AUTHORIZATION

    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.

    PREVIOUS RESIDENCE

    If does not apply - write N/A

    ADDITIONAL APPLICANTS

    Please add the names of each applicant applying with you.

    EMPLOYMENT INFORMATION

    Provide at least three years of history. Attach additional files, if needed.

    Attach proof of income, copy of paystub, employer letter, etc.

    If anything does not apply to you, write N/A in the spaces

    If anything does not apply to you, write N/A in the spaces

    If anything does not apply to you, write N/A in the spaces

    If anything does not apply to you, write N/A in the spaces

    ADDITIONAL INCOME FOR MONTHLY EXPENSES

    If not applicable, write N/A

    BANK ACCOUNT INFORMATION

    MONTHLY PAYMENTS

    Additional monthly expenses

    Car Insurance

    Cell Phone

    Credit Card

    Personal Loan

    VEHICLE

    Include any cars, trucks, vans, motorcycles, trailers, boats and recreational vehicles.

    VEHICLE 2

    PETS

    OTHER INFORMATION

    If "yes"

    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:

    N/A if not applicable

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