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;
------------------------------------------------------------------------------------------------------------------------------
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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