Property Name: 637 - 5th St. Donora PA 15033 Fax Number:
RENTAL APPLICATION
Applicant: _____________________ SS#: ________________ Date of Birth: ________
Co-Applicant: ___________________ SS#: ______________ Date of Birth: ________
List all other persons to occupy the house:
Name: _____________________________ SS#:__________________ Date of Birth: ________
Name: ____________________________ SS#:__________________ Date of Birth: ________
Name: ____________________________ SS#:__________________ Date of Birth: ________
Name: ____________________________ SS#:__________________ Date of Birth: ________
Employment – Applicant Employment – Co- Applicant
Employer _______________________ Employer ______________________
Address ________________________ Address ___________________________
Phone ___________Length of Time_________ Phone __________Length of Time_________
Position __________Supervisor_____________ Position ___________Supervisor__________
Approx. Income $______ wk. mo. yr Approx. Income $ _______ wk. mo. yr
Present Street Address
Present Street Address: _____________________________________________________
City / State / Zip: ___________________________________________________________
Length of Time: __________ Own/Rent Do you have a lease? Y/N Expires When? _____
Name of Landlord or Mortgage Holder: __________________________ Phone No: ___________
Previous Street Address
Previous Street Address: _____________________________________________________City / State / Zip: ___________________________________________________________
Length of Time: __________ Own/ Rent Do you have a lease? Y/N Expires When? _____
Nearest Relative (Other than Husband or Wife) – WHO TO REACH IN AN EMERGENCY:
Name ___________________ Relationship __________________ Phone ________
Address _____________________________ City/State/Zip ________________________
FALSE INFORMATION GIVEN ON AN APPLICATION IS IN ITSELF GROUNDS FOR
REJECTION OF THE APPLICATION OR TERMINATION OF TENANCY.
Authorization for Release of Information
I authorize without reservation, any party (including, but not limited to, employers, law enforcement agencies, state agencies, institutions and private
information bureaus or repositories) contacted by prospective property manager or property owner to furnish any or all of the above mentioned
information. I release and discharge all liability from all companies, agencies, officials, officers, employees and other persons, who, in good faith
provide to prospective property manager or property owner. the above mentioned information as requested, in order to successfully complete a
background investigation of my rental application. I will allow a photocopy of this authorization to be as valid as the original.
.
Date: ___________________ Applicant’s Signature: _______________________
Home Phone: _______________ Co-Applicant’s Signature: ____________________
Work Phone:___________________ Other Occupant’s Signature: __________________
Equal Housing Opportunity
Rental Application PDF (download)
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