CENTRAL PENNSYLVANIA LANDLORD ASSOCIATION



CENTRAL PENNSYLVANIA LANDLORD ASSOCIATION

RENTAL APPLICATION

DATE _______/______/________ AMT. OF SECURITY DUE $________________

Property location Requested move in date___/___/_____.

Personal Information

First applicant (please print) (first, middle & last name)

_____________________________________.

Social security number ________Date of birth _____/____/________.

Present address ____________________________________________________________________________

Street City State Zip Code

Telephone number_____________________ Driver's license number __________________Exp. Date_______

How long have you lived at the above address? ____________________________

Current landlord's name and telephone number ___________________________________________________

How much rent are you currently paying? $ _______. Utilities you pay? Gas ___Elect. ____W/S_____

Why are you moving?________________________________________________________________________

__________________________________________________________Did you give notice? _______

Previous address where you lived ______________________________________________________________

How long there? __________Why did you move?__________________________________________________ __________________________________________________________________________________________

What were you paying in rent there? _____Landlord's name ____________________________Ph # _________

Names & ages of others living with you at the last address___________________________________________ __________________________________________________________________________________________

Do you have pets? ______What kind? __________________Breed, weight, size? ________________________ __________________________________________________________________________________________

Does your pet have all injections and licenses?____________________________________________________ Is your pet neutered? If a cat, is it declawed? __________________________________________

If you have a pet, you must carry liability insurance & provide me with a copy of the policy. Do you have insurance at this time?_________

Second Applicant (first, middle, last name)________________________________________________

Birth date ________ Social security number _____________________License # ____________Exp. date_____ Present address (street, city, state, zip) __________________________________________________________

Landlord's name and telephone number __________________________________________________________

Name and ages of others living with you at the last address. __________________________________________

__________________________________________________________________________________________

Financial Information

First applicant’s occupation? ______________________________________________________________

Full time or part time If part time, how many hours a week do you work? __

Name of employer ______________________________Position you hold ______________________________

Address of employer ______________________________________________________________________

How long have you been employed? _______ Gross Monthly income $ .

Person to contact Telephone # ____________________________________________________

Previous employer (if less than 2 years) _________________________________________________________

Their phone # How long did you work there? ___________________

Gross monthly income $_________Why did you leave? _____________________________________

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Second Applicant’s Occupation _____________________________________Full or part time? __________

Employer Position ________________________________________

Address of employer ________________________________________________________________________

How long were you employed there? _________________ Gross monthly income $ _____________________

Person to contact Telephone #

Previous employer How long there?

Why did you leave? _________________________________________________________________________

Credit References

Bank (name & branch) ______________________ Type of account (loan, savings, etc.) ______________

Is the account open? _______

Other credit references Is the account open? _________________

Please list other current credit obligations:

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

Personal References (Please list two with names and telephone numbers, No relatives please!

____________________________________________________________________________

____________________________________________________________________________

Background Information

How long have you lived in Central PA? Do you plan to stay? _

How long? ________Does anyone smoke?______ Do you have renters insurance?_________________

Do you have a waterbed? Is it insured? __ . With whom _

Are you presently being evicted? If so please explain. (Use the back side if more room is needed to explain any of the following .... )_______________________________________________________________

__________________________________________________________________________________________

Have you ever been evicted or broken a lease? If yes, please explain. ____________________________

__________________________________________________________________________________________

Has your security deposit always been returned? _______ If not, please explain__________________________

__________________________________________________________________________________________

Have you ever been arrested for drug use or convicted of using drugs? If so please explain _________

__________________________________________________________________________________________

Have you been convicted of a felony? ________

Do you currently have ANY utilities in your name?

Telephone Electric __________Gas ___________Oil ___________ Water/Sewer ____________

Person to contact in the event of an emergency __________________

Telephone # Relationship to you ______________________________________

Closet living relative________________________________________ Telephone # _____________________

Address _____________________________________________________________________________________

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Vehicle Information

Vehicle # 1 Year, make, model, color __________________________________________________________

Plate # _______________________________State registered in

Is the vehicle financed? _____ Monthly payment $ Bank! S&L __________________

Vehicle # 2 Year, make, model, color _________________________________________________________

Plate # State registered in _

Is the vehicle financed?______ Monthly payment $_____ Bank! S&L _______________________________

Any other vehicles? _______If so describe year, make, model, color. ___________________

How did you hear about this vacancy? __ newspaper __ friend __ sign __ agency __ tenant who is a friend

By signing below, applicant (s) states that all information given above is correct and truthful under Penalty of Perjury. Applicant (s) agrees to a credit check, criminal check, judgment search, and verification of all references. If any information is found to be false, the applicant (s) forfeits ALL monies paid. Security deposit, credit &/or criminal check fees will NOT be returned. The applicant (s) further agrees to be evicted if after moving in, information provided therein is found to be false.

I (We) hereby make application to lease real estate and certify that the above information is true and correct. I authorize the owner or his agent to verify information and obtain credit reports. The application fee collected to cover the costs associated with this application is non-refundable under any circumstances. This application is subject to approval prior to acceptance as a tenant.

Signatures of all over 18 years old.

_______________________________________ _____________________________________________

_______________________________________ _____________________________________________

_______________________________________ ____________________________________________

Applications cannot be processed until the following has been received. Deposit of: $________

to hold property if required, $ _________ application fee.

Total required $__________.

________ Two copies of most recent pay stubs and/or child support, alimony, social security or disability income verification

_________ Copy of drivers license, front and back, for all drivers over 18 years of age, or state photo ID

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In the event you do not qualify, would you be able to get a co-signer who owns real estate? ______

Name, address, and phone number. This person would also be required to complete the application process.

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Additional information, notes;

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RECEIPT FOR CREDIT/CRIMINAL REPORT FEE

DATE _____/_____/______

_______________________________ has paid a NON-REFUNDABLE Credit and/or Criminal

report fee of $ The payment of this fee does NOT GUARANTEE the applicant (s) will be

accepted for the above residence applied for.

SIGNATURE(S) _

Landlord(s) signature or representative:

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