Application for Rent

8/8/2019 Application for Rent

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CONSUMER NOTICE FOR TENANTSTHIS IS NOT A CONTRACT(Not to be used when licensee is subagent for tire landlord, agentfor tile tenant or transaction licensee. 111 these situations tile full Consumer Notice must beused)

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1 (Licensee) ~ C ~ o " - r y Z - . . . ! . . F - " a ' " " s " _ t hereby states that with respect to this property (describe property),2 , I am acting in the following capacity: (check one)3 04 05 ~

(i) Owner/Landlord of the Property;(ii) A direct employee of the Owner/Landlord; OR(iii) An agent of the Owner/Landlord pursuant to a property management or exclusive leasing agreement.

6 I acknowledge that I have received this Notice:7 Date: _89013

5 Iertify that Ihave provided this Notice:

Print (Consumer) Print (Consumer)

Signed (Consumer) Signed (Consumer)

Address (Optional) Address (Optional)

Phone Number (Optional)

(Licensee) (Date)

Phone Number (Optional)

RENTAL APPLICATIONThis fonn recommended and approved for, but not restricted to use by, the members of the Pennsylvania Association ofREALTORS (PAR).89 Provide at least two years of history in Sections 1 &2. Fill out all sections completely.

Attach additional sheets if more space is needed. Please type or print all information clearly.

2 Address _Utilit ies Paid By Landlord: _

4 Utilit ies Paid By Tenant: _5 Move-in Date Term Monthly Rent $ Application Fee $ 25 o r $40 c o u p l e6 Deposits S e c u r i t y $ . Other $ , _0See Advance Payment Addendum for additional information

PROPERTY INFORMATION

1.APPLICANT INFORMATION (Attach Photo ID)APPLICANT 10Check here if additional information is attached0 FullName _1 Is Applicant at least 18 years old? 0 Yes 0 No

Social Security Number _3 Driver's License No./State _4 Home Phone Work Phone _5 Present Address & ZIP _6 0 0w n 0 Rent7 From: To: RentIMortgage $ /mo.

LandlordIMortgage Co. Name & Phone _90

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Previous Address & ZIP --:=-__ - - = = - _ __________________ 0 0w n 0 RentFrom: To: RentIMortgage $ /mo.LandlordIMortgage Co. Name & Phone _

In case of emergency, contact _Relationship Phone(s) _

m Pennsylvania Association ofI . . I : : ! I R E A L T O R S RfALTORS TIle " * * fer AMI&b Itae I. ~Fonn generatedby: Trueserms" from REVEAL~SYSTEMS.lnc. 800-499-9612

APPLICANT INFORMATION (Attach Photo lD)APPLICANT 2 0Check here if additional information is attachedFull Name _Is Applicant at least 18 years old? 0 Yes 0 NoSocial Security Number _Driver's License No./State _Home Phone Work Phone _Present Address & ZIP _

DOwn 0 Rent----------------rom: To: RentIMortgage $ /mo.LandlordIMortgage Co. Name & Phone _

Previous Address & ZIP _DOwn 0 Rent------------------------From: To: RentIMortgage $ /mo.

LandlordIMortgage Co. Name & Phone _

In case of emergency, contact _Relationship Phone(s) _

RAPage 1o f4

~EQUAL HOUSINGOPPORTUNITY

COPYRIGHT PENNSYLVANIA ASSOCIATION OF REALTORS@20054/05


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2. EMPLOYMENT INFORMATIONAPPLICANT 1 0Check here if additional information is attachedEmployer _City/State _Phone Supervisor _Position _Gross Income: $ Imo. 0 R

$ /hr., for hrs. per week (on average)Employed From To _0 PROOF OF INCOME ATTACHEDPrevious Employer _City/State _Phone Supervisor _Position _Gross Income: $ .....;/mo. O R

$ /hr., for hrs. per week (on average)Employed From To _

EMPLOYMENT INFORMATIONAPPLICANT 2 0Check here if additional information is attachedEmployer _City/State _Phone Supervisor _Position _

$ .....;/m o. OR$ /hr., for hrs. per week (on average)

Employed From To _o PROOF OF INCOME ATTACHEDGross Income:

Previous Employer _City/State _Phone Supervisor _Position _Gross Income: $ . .....;/m o. OR

$ /hr., for hrs. per week (on average)Employed From To _

3. OTHER INCOME Alimony, child support, or separate maintenance income need not be revealed if Applicant does not wish to haveit considered as a basis for paying this obligation. o Check here if additional information is attached

Applicant Monthly Amountource

4. BANK ACCOUNT INFORMATION o Check here if additional information is attachedApplicant Bank/Credit Union Address/Branch Account Number Account Type Balance

5. LIABILITIESIMONTHL Y PAYMENTS o Check here if additional information is attachedApplicant Lender/Creditor Loan Number Loan Type Balance Due Monthly Payment

6. VEHICLE INFORMA nON o Check here if additional information is attached4

Make/Model Yearpplicant

7.OTHER OCCUPANTS (FULL)___________________ 0 18 or older___________________ 0 18 or older

Color License Number/State

o Check here if additional information isattached__________________ 0 18 or older__________________ 0 18 or older8. PETS 0Check here if additional information isattached

Does any Applicant or Occupant own any pets? 0Yes 0No If yes, list and describe: (type, name, breed, age, weight, gender, etc):

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RA Page 2 of 4Form generatedby: True Forms" from REVEAL ~ SYSTEMS,nc. 800-499-9612


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9. OTHER INFORMATIONApplicant 1 Applicant 2DYe sON 0 0 Yes 0No

0 DYes 0No 0 Yes 0No1 DYes 0No 0 Yes 0No2 DYes 0No 0 Yes 0No3 DYes 0No 0 Yes 0No5678

1

o Check here if additional information is attachedHave you ever declared bankruptcy or suffered foreclosure? If yes, list any payments: $ . _Have you been evicted or sued for unpaid rent or damages to leased property?Have you ever refused to pay rent for any reason?Have you ever been convicted ofa felony or misdemeanor?Have you at any time on or since January 1, 1998 been obligated to pay support under an orderon record in any Pennsylvania county? If yes, list the County and the Domestic Relations File orDocketNumber: _Amount $ , Are you delinquent? _

If you answered "yes" to any of the above questions, please explain: _

23 10. CONDITION OF PROPERTY4 The Property will be leased in the same condition as it is shown unless otherwise agreed to in writing in paragraph II below or in an attached5 addendum.6 11. SPECIAL PROVISIONS7

90123 12. AUTHORIZATION Applicants authorize Landlord or Broker to obtain any information deemed necessary to evaluate this Application.4 This information may include, but is not limited to, credit reports, criminal history, judgments of record, rental history, verification of5 employment and salary, employment history, vehicle records, and licensing records. Broker may report to Landlord any information6 obtained by Broker for evaluation of the Application. Applicants acknowledge that all information in the Application is true andcorrect. Applicants acknowledge that if they present false or incomplete information Landlord may reject this Application. Applicantsunderstand that giving false or incomplete information may result in forfeiture of any payments made in connection with this Rental9 Application.0 I HAVE READ AND AGREE TO THE PROVISIONS AS STATED.1 APPLICANT _ DATE _2 APPLICANT _ DATE _

3 LANDLORDIBROKER (Company Name) _OFFICEADDRESS _

5 PHONE(S) FAX E-MAIL _6 AGENTIRECEIVED BY _ DATE _

7890123

FOR OFFICE USE ONLYLandlord: o ACCEPTEDEmployment: oREJECTEDCredit Report:ID Verification: BY:Mise: DATE:,,' ,. ,

RA Page 3 of4Form generat ed by:'I'rue scrms" fr o m R EV EA l~SY STEMS, In c. 800-4999 612


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NOTICES AND INFORMATIONCIVIL RIGHTS ACTS NOTICEFederal and state laws make it i llegal for a landlord, broker, or anyone to use RACE, COLOR, RELIGION or RELIGIOUS CREED, SEX, DISABILITY (physical ormental), FAMILIAL STATUS (children under 18 years of age), AGE (40 or older), NATIONAL ORIGIN, USE OR HANDLINGfTRAINING OF SUPPORT ORGUIDE ANIMALS, or the FACT OF RELATIONSHIP OR ASSOCIA TION TO AN INDIVIDUAL KNOWN TO HAVE A DISABILITY as reasons for refusing tosell, show, or rent properties, loan money, or set deposit amounts, or as reasons for any decision relating to the sale or lease of property. It is also an unlawfuldiscriminatory practice to evict or attempt to evict an occupant ofa housing accommodation before the end of the term of the lease because of the pregnancy or birth ofa child.

FAIR CREDIT REPORTING ACT NOTICE15 U.S.c. 1681 et. seq.

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 12 of thisApplication, 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, andtelephone number of the consumer reporting agency (including a toll-free telephone number established by the agency if the agency compiles and maintains files onconsumers 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 isunable to provide you with the specific reasons why your application was denied, (3) information about how to obtain a free copy of your consumer report from theconsumer reporting agency, and (4) information about how to dispute the accuracy or completeness of any information in a consumer report furnished by the agency. Ifthe 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.

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Application for Rent