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Pennsylvania Rental Application Form


Pennsylvania Rental Application Form
Pennsylvania Rental Application Form
RENTAL APPLICATION
1. A non-refundable application fee of $____ per applicant is required when an application is submitted. All individuals
age 18 or over that intend to reside in the property must apply.
2. The applicant must provide their photo ID and proof of social security number before a showing.
3. The applicant must complete the application in full. Put N/A in any areas that do not apply.
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
4. A hold deposit equal to one month’s rent must be paid in full to hold a rental unit. A hold deposit is non-refundable 3
days after approval. NO UNIT WILL BE HELD WITHOUT A DEPOSIT.
5. The lease must be signed within ___ days of approval, or the hold deposit will be forfeited.
APPLICANT INFORMATION
Full Name _____________________________________ Is applicant at least 18 years old c Yes c No
Social Security Number __________________________ Date of Birth _________________________________
Drivers License / ID No. _________________________ State _______________________________________
Home Phone ____________________ Work Phone ____________________ Cell Phone ____________________
Bank/Credit Union_________________________Account #___________________Account Type______________
Emergency Contact ______________________________ Relationship _________________ Phone ____________
RESIDENIAL INFORMATION
(two year history)
Current Address ___________________________________________________________ c Own c Rent
From ________________________ to ______________________ Rent/mortgage $ _______________ /month
Landlord/Mortgage Co. Name _______________________________________ Phone______________________
Prior Address _____________________________________________________________ c Own c Rent
From ________________________ to ______________________ Rent/mortgage $ _______________ /month
Landlord/Mortgage Co. Name _______________________________________ Phone______________________
EMPLOYMENT INFORMATION
(two year history)
Employer ________________________________________ Position ___________________________________
Address ______________________________________________________________________________________
Phone __________________________________________ Supervisor __________________________________
Gross Income $ ______________ /mo. OR $ _____________ /hour for __________ hours per week on average
Employed From ______________________ To ____________________
Previous Employer ________________________________ Position ___________________________________
Address ______________________________________________________________________________________
Phone __________________________________________ Supervisor __________________________________
Gross Income $ ______________ /mo. OR $ _____________ /hour for __________ hours per week on average
Employed From ______________________ To ____________________
OTHER INCOME
Alimony, child support, or separated maintenance income need not be revealed if Applicant does not wish to have it considered as a basis for paying this obligation.
Source ____________________________________________________________ Amount __________________
Source ____________________________________________________________ Amount __________________
Applicant Initials ____________________Date________________
LPM 106a-042011
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Pennsylvania Rental Application Form