Pennsylvania Rental Application Form

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Pennsylvania Rental Application

Pennsylvania Rental Application

This form allows for a person to apply for a apartment or home in Pennsylvania. This form must be submitted to the landlord or management company, there may be a small filing fee. If approved the applicant will be notified of when their lease is ready for signing.

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Rental Application

First Name Middle Name Last Name Social Security Number

Date of Birth Drivers License No. State Home Phone Number

Email Address: Cell Phone Number

1 Present Address City State Zip Code

Date in Date out Owner/Mgr Owner/Mgr Phone #.

Reason for Moving

2 Previous Address City State Zip Code

Date in Date out Owner/Mgr Owner/Mgr Phone #.

Reason for Moving

Proposed

Occupants

List All

in addition

to yourself

Name Age Name Age

Do you have pets? Yes / No If yes, describe (type, weight, age, etc.) Any smokers in your household? Yes / No

1 Present

Occupation

How long with

this employer

Name of your

supervisor

2 Previous

Occupation

How long with

this employer

Name of your

supervisor

Employer

Name

Employer

Address

Employer

phone #

Employer

Name

Employer

Address

Employer

phone #

Rental Application

Current gross income $_ Per

Check circle below Please list ALL of your financial obligations below:

Wk.

Mo.

Yr.

In case of emergency, notify: Address Phone City Relationship

1.

Personal References Address Phone City Length of acquaintance

1.

2.

Automobile: Make Model Year Reg. State Vehicle license number

Additional vehicles, if any

Have you ever filed for bankruptcy? _ Have you ever been evicted from any tenancy or had an eviction notice served on you?

Have you ever willfully and intentionally refused to pay any rent when due? Have you ever been convicted of a misdemeanor or felony

other than a traffic or parking violation? Are you a current illegal abuser or addict of a controlled substance? Have you ever been

convicted of the illegal manufacture or distribution of a controlled substance? Have you ever been asked to move out of a residence?

If yes to any of the above, please indicate date/circumstance of occurrence:

Authorization

I hereby authorize to order a consumer credit report, eviction reports, bad check

searches, a social security number verification, and verify other information, including employer and landlord references, that is needed to

determine responsibility and reliability as a tenant in a building we manage. It is understood that a copy of this application will a lso serve as this

authorization. All personal information obtained is to be used exclusively in the processing of my rental application. P rivacy Act Notice: this

information is used by the agency collecting it or its assignees in determining whether you qualify as a prospective tenant. It will not be disclosed

outside the agency except as required and permitted by law. You do not have to provide this information, but if you do not, your application for

approval as tenant may be delayed or rejected.

Dated: , 20_ Signature of Applicant: _