Fillable Printable Pennsylvania Rental Application
Fillable Printable Pennsylvania Rental Application
Pennsylvania Rental Application
Sources
Amounts
$
$
Pennsylvania Rental Application
TO APPLICANT
This application must be completed in full. If “None”, so indicate. All items are subject to verification. A false or willfully omitted statement in this
application will be grounds for its rejection, or the cancellation of your lease at the option of Landlord.
This application must be accompanied by a fee of $ for processing and credit reports. This fee is not refundable.
Landlord
Phone No.
Property Address
1. APPLICANTS
Apt. No.
Date
Name
Social Security No.
Date of Birth
Occupation
Name
Home Phone
Business Phone
Marital Status
Driver’s License No.
Pets (Special written permission required)
Children’s Names and Ages
Why are you moving?
Present Rent
Utilities
2. LAST THREE RESIDENCES
Present Address, City and State =ip Code
Dates of Occupancy
Landlord’s Name, Address, Phone No.
Previous Address, City and State
Previous Address, City and State
3. EMPLOYMENT
Supervisor’s Name
Present Employer
Address and Phone No.
Zip Code
Dates of Employment
Previous Employer
4. EMPLOYMENT OF SPOUSE
Supervisor’s Name
Present Employer
Address and Phone No.
Zip Code
Dates of Employment
Previous Employer
5. LIST OF MOTOR VEHICLES
Do You Desire Garage Rental?
❐
Yes
❐
No
Make
Year
Color
Type
License No. and State
Previous Employer
6. LIST OF YOUR PROPERTY
WHICH WILL BE LOCATED ON THE RENTAL PREMISES
7. MONTHLY INCOME
Items
Value
Furniture
$
TVs, Stereos, Radios, etc.
Total
Company or Person
Reason
Time Left
Monthly Amount
$
$
8. CURRENT LOANS AND OBLIGATIONS
9. FINANCIAL REFERENCES
Total
Name
Address
Account No.
Bank
Savings:
Checking:
Charge Account
Charge Account
10. PERSONAL REFERENCES
Name
Relationship
Address
Phone
In Case of Emergency, Notify:
11. GENERAL
Have you received welfare assistance within the last two years? ...............................................................................................................................
❐
Yes
❐
No
Have you received unemployment compensation within the last two years? .............................................................................................................
❐
Yes
❐
No
Are you eligible for any governmental housing subsidy? ...........................................................................................................................................
❐
Yes
❐
No
Have you ever been ejected for non-payment of rent or otherwise failed to meet your lease obligations? If Yes, explain in remarks. ....................
❐
Yes
❐
No
Have you ever been convicted or pleaded guilty or “no contest” to
a
felony (whether or not resulting in
conviction)?
If Yes, explain in remarks. ......................................................................................................................................................................................
❐
Yes
❐
No
Have you ever been convicted or pleaded guilty or “no contest” to
a
misdemeanor involving sexual misconduct (whether or
not
resulting in conviction)? If Yes, explain in remarks. ..................................................................................................................................
❐
Yes
❐
No
12. REMARKS
13. RENTAL INFORMATION How Did You Hear About This Rental Unit?
❐
Classified Newspaper Ad
❐
Yellow Pages
❐
Internet Listing
❐
Saw Rental Unit While Driving By
❐
Web Site
❐
Personally Recommended
❐
Other
I CERTIFY THAT the above information supplied is true and complete to the best of my knowledge. I authorize verification of all information given;
and understand that additional information will be obtained from the Apartment Association of Northwestern Pennsylvania, Inc., the Credit Bureau, and
other services. I understand that my rent payment record, my performance of rules and lease obligations, and my treatment of the premises will be
reported to credit reporting agencies and to other landlords.
I understand that this application may be accepted or rejected at the discretion of the landlord. I understand and agree that rents and deposits paid
toward the rental unit will be refunded only if this application is rejected by the landlord; and that otherwise, those rents and deposits will be applied as
specified in the lease agreement.
Date:
Signatures:
DISCLAIMER
