Pennsylvania Rental Application

If Yes, Describe: ________________________________________________________

 

Ever Been Evicted?  ☐ Yes ☐ No

If Yes, Describe: ________________________________________________________

CURRENT EMPLOYMENT

Company: _____________________ Occupation/Title: _____________________          How Long? ___________ Gross Income: $_____________ (From Prior Year Tax Filing)

Street Address:

City: ________________ State: ________________ Supervisor: __________________

PREVIOUS EMPLOYMENT

Company: _____________________ Occupation/Title: _____________________ How Long? ___________ Gross Income: $_____________)

Street Address:

City: ________________ State: ________________ Supervisor: __________________

CURRENT RESIDENCE

Type (Apt, Home, Condo): ________________ Square Feet (SF): _____________SF Bedrooms: ______ Rent Amount: $_______________/Month

Street Address:

City: ________________ State: ________________ Zip: ________________                How long at this Address? ___________ Current Lease Expiration Date: ___________ Desire for Moving? ______________________________________________________

CURRENT LANDLORD

Name:

Address:

Phone:                               E-Mail:

PREVIOUS RESIDENCE - 1

 

Type (Apt, Home, Condo): ________________ Square Feet (SF): _____________SF Bedrooms: ______ Rent Amount: $_______________/Month

Street Address:

City: ________________ State: ________________ Zip: ________________

Start Date:                         End Date:

PREVIOUS LANDLORD - 1

Name:

Address:

Phone:                               E-Mail:

PREVIOUS RESIDENCE - 2

Type (Apt, Home, Condo): ________________ Square Feet (SF): _____________SF Bedrooms: ______ Rent Amount: $_______________/Month

Street Address:

City: ________________ State: ________________ Zip: ________________

Start Date:                         End Date:

PREVIOUS LANDLORD - 2

Name:

Address:

Phone:                               E-Mail:

PERSONAL REFERENCES

Full Name: ____________________________ Relationship: __________________

E-Mail:                                                            Phone:

Full Name: ____________________________ Relationship: __________________

E-Mail:                                                            Phone:

 

Full Name: ____________________________ Relationship: __________________

E-Mail:                                                            Phone:

FINANCIAL INFORMATION

Bank: _________________ Account # _______________ Routing # _______________ Branch Location ____________________________ Type: ☐ Checking ☐ Savings

Bank: _________________ Account # _______________ Routing # _______________ Branch Location ____________________________ Type: ☐ Checking ☐ Savings

Credit Card: _________________ Card # _____-_____-_____-_____ Limit: $________ ☐ Visa ☐ MasterCard ☐ Discover ☐ Amex ☐ Diner’s Club

Credit Card: _________________ Card # _____-_____-_____-_____ Limit: $________ ☐ Visa ☐ MasterCard ☐ Discover ☐ Amex ☐ Diner’s Club

Credit Card: _________________ Card # _____-_____-_____-_____ Limit: $________ ☐ Visa ☐ MasterCard ☐ Discover ☐ Amex ☐ Diner’s Club

CONSENT AND ACKNOWLEDGMENT

I hereby certify that I am at least 18 years of age. Applicant represents that all              information given on this application is true and correct. Applicant hereby authorizes   verification of all references and facts, including but not limited to current and previous landlords, employers, and personal references. Applicant hereby authorizes

owner/agent to obtain any and all Unlawful Detainer, Credit Reports, Telechecks, and/or Criminal Background Reports. Applicant agrees to furnish additional credit and/or           personal references upon request. Applicant understands that incomplete or incorrect    information provided in the application may cause a delay in processing which may        result in denial of tenancy. Applicant hereby waives any claim and releases from liability any person providing or obtaining said verification or additional information.

 

Applicant’s Signature _______________________ Date _______________

 

CONSUMER DISCLOSURE

I/we, the undersigned, authorize the Landlord and its agents to obtain an investigative consumer credit report including but not  limited to credit history, OFAC search, landlord/tenant court record search, criminal record search and registered sex offender   search. I authorize the release of information from previous or current landlords, employers, and bank representatives. This       investigation is for resident screening purposes only and is strictly confidential. This report contains information compiled from   sources believed to be reliable, but the accuracy of which cannot be guaranteed. I hereby hold Landlord and its agents free and harmless of any liability for any damages arising out of any improper use of this information.

Important information about your rights under the Fair Credit reporting Act:

       You have a right to request disclosure of the nature and scope of the investigation.

       You must be told if information in your file has been used against you.

       You have a right to know what is in your file, and this disclosure may be free.

       You have the right to ask for a credit score (there may be a fee for this service).

       You have the right to dispute incomplete or inaccurate information. Consumer reporting agencies must correct inaccurate, incomplete, or unverifiable information. These reports are being processed by On-Site.com, P.O. Box 1514, Los Altos, CA 94023- 1514, (877) 222-0384. A summary of your rights under the Fair Credit Reporting Act is available by visiting or          writing (Para information en espanol, visite o escribe): http://www.ftc.gov/credit

Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Avenue N.W., Washington D.C. 20580.

In connection with my application for housing, I understand that the property owner/agent may obtain one or more consumer reports, which may contain public information, for the purposes of evaluating my application. These consumer reports will be obtained from      one or more of the following consumer reporting agencies:

       Equifax, E.C.I.F., P.O. Box 740241, Atlanta, GA, 30374-0241, (800) 685- 1 1 1 1

       Trans Union, Regional Disclosure Center, 1561 Orangethorpe Ave., Fullerton, CA, 92631, (714) 738-3800

       Experian (TRW), Consumer Assistance, P.O. Box 949, Allen, TX, 75002, (888) 397-3742

       On-Site Manager, Inc., P.O. Box 1514, Los Altos, CA, 94023- 1514, (877) 222-0384

California Residents

Under California law, these consumer reports are defined as investigative consumer reports. These reports may contain information on my character, general reputation, personal characteristics and mode of living. In connection with my application for housing, I      authorize owner/agent to obtain a consumer report from the consumer reporting agencies listed above.

Signature: ________________________________________

Name Printed: ________________________________________

Date: ________________________________________

If you would like to receive a copy of any investigative consumer report at no cost to you, please initial here: ______ If you would like to receive a copy of any credit report at no cost to you, please initial here: ______

PLEASE NOTE:

Under Section 1786.22 of the California Civil Code, if you wish to dispute the accuracy or completeness of any item in the consumer report, you may contact the consumer reporting agency named above and request an investigation. You also may view the file          maintained on you by the above credit reporting agency during normal business hours. You can receive a copy of your file by            providing proper identification and paying any related-copy costs. You may also receive a summary of the file by telephone. The       agency is required to have employees available to explain your file to you, and they must explain any coded information in your file.  You can bring someone with you to view the file, so long as they have identification.

Washington Residents

In the event of a denial or other adverse action, you have a right to obtain a free copy of the consumer report from the screening company or credit reporting agency

Massachusetts Residents

An applicant for employment or for housing or an occupational or professional license with a sealed record on file with the                commissioner of probation may answer ‘ no record’ with respect to an inquiry herein relative to prior arrests, criminal court                

appearances or convictions. An applicant for employment or for housing or an occupational or professional license with a sealed     record on file with the commissioner of probation may answer ‘ no record’ to an inquiry herein relative to prior arrests or criminal       court appearances. In addition, any applicant for employment or for housing or an occupational or professional license may answer ‘ no record’ with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution.