Broker/Licensee for Landlord
Broker/Licensee for Tenant
Property Information (to be supplied by Broker for Landlord)
1. APPLICANT INFORMATION (Provide at least two years of history)
2. EMPLOYMENT INFORMATION (Provide at least two years of history. Attach additional sheets if more space is needed)
3. OTHER INCOME USED FOR MONTHLY EXPENSES
4. BANK ACCOUNT INFORMATION
5. MONTHLY PAYMENTS
7. PETS (Include Type: Cat, dog, etc. / Breed /Age/ Gender /Weight)
8. ADDITIONAL INFORMATION
- 9. CONDITION OF PROPERTY
The Property will be leased in the same condition as it is shown unless otherwise agreed to in writing.
10. APPLICATION FEE
The Application Fee is NON-REFUNDABLE and will not be applied towards rent or other financial obligations should
Applicant be approved, nor refunded if not approved. Applicant agrees that this sum is paid in consideration of
Landlord/Broker for Landlord’s review and/or verification of the information stated in the application.
11. OBLIGATION TO ENTER INTO LEASE AGREEMENT/ DAMAGES
Upon submission of this Application, Landlord/Broker for Landlord reserves the right to remove property from the available
rent list. If this Application is denied by Landlord, the Application Deposit shall be refunded to Applicant. If this Application
is approved and Applicant fails to rent the Property, Landlord shall be entitled to retain the Application Deposit.
12. CONVICTED SEX OFFENDERS (MEGAN'S LAW)
The Pennsylvania General Assembly has passed legislation (often referred to as “Megan’s Law,” 42 Pa.C.S. § 9791 et seq.)
providing for community notification of the presence of certain convicted sex offenders. Potential tenants are encouraged
to contact the municipal police department or the Pennsylvania state Police for information relating to the presence of sex offenders near a particular property, or to check the information on the Pennsylvania State Police Web site at
13. NOTICE TO PERSONS OFFERING TO SELL OR RENT HOUSING IN PENNSYLVANIA
Federal and state laws make it illegal for Landlord, Broker, or anyone to use RACE, COLOR, RELIGION or RELIGIOUS
CREED, SEX, DISABILITY (physical or mental), FAMILIAL STATUS (children under 18 years of age), AGE (40 or older),
Relations Commission, or your own attorney for further guidance.
NATIONAL ORIGIN, USE OR HANDLING/TRAINING OF SUPPORT OR GUIDE ANIMALS, or the FACT OR RELATIONSHIP
OR ASSOCIATION TO AN INDIVIDUAL KNOWN TO HAVE A DISABILITY as reasons for refusing to sell,
show, or rent properties, loan money, or set deposit amounts, or as reasons for any decision relating to the sale of property.
The municipality in which the Property is located may have enacted an ordinance or other law that extends the protections for
access to housing to additional classes of individuals, such as gay, lesbian, bisexual and transgender individuals and couples.
Broker and Landlord are advised to check with your local municipality, representative from the Pennsylvania Human
14. FAIR CREDIT REPORTING ACT
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 16 of this Application, 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, and telephone number of the consumer reporting agency (including a toll-free telephone
number established by the agency if the agency compiles and maintains files on consumers 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 is unable to provide
you with the specific reasons why your application was denied, (3) a numerical credit score, the range of possible credit scores
under the model used, up to four of the key factors that led to the denial, and the date the credit score was created (4) information about
how to obtain a free copy of your consumer report from the consumer reporting agency, and (5) information about how to dispute the
accuracy or completeness of any information in a consumer report furnished by the agency. If the 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.
15. SPECIAL CLAUSES
16. AUTHORIZATION - By initialing below, Applicant provides the described authorization.
- Applicant authorizes Landlord or Broker for Landlord to obtain any information deemed necessary to evaluate this
Application. This information may include, but is not limited to, credit reports, criminal history, judgments of record,
rental history, verification of employment and salary, employment history, vehicle records, and licensing records.
Broker for Landlord may report to Landlord any information obtained by Broker for Landlord for evaluation of the
Application. Applicant acknowledges that all information in the Application is true and correct. Applicant acknowledges
that if applicant presents false or incomplete information Landlord may reject this Application. Applicant
understands that giving false or incomplete information may result in forfeiture of any payments made in connection
with this Rental Application.
- Applicant agrees that Broker(s), his/her agent(s) and/or employee(s) may provide Applicant’s social security number,
individual taxpayer identification number, driver’s license information and date of birth to lenders, title agencies,
credit reporting companies, or others as necessary for obtaining reports or information from a credit reporting
agency, determining the existence of domestic liens, or for obtaining a criminal background report (for prospective
tenants only). Applicant understands that Brokers have no control over the use of any information after it is
disclosed to a third party and agrees to release and hold Brokers harmless from any and all liability for any
misuse or subsequent disclosure by any third party of the information or reports disclosed by Broker pursuant
to the terms of this authorization.