Rental Application – Washington, PA House For Rent

Desired Move In Date*

Applicant Renter's Name*

First Last

Fill in legal name

Home Phone*

Work Phone

Cell Phone

Email

Fax

Fax number we may reach you at.

Drivers License Number / State*

Please fill in your drivers license number and the state it was issued in.

Vehicle Make / Model / Color / Year

License Plate Number

Additional Occupant Name

First Last

Relationship to Occupant

Additional Occupant Name

First Last

Relationship to Occupant

Additional Occupant Name

First Last

Relationship to Occupant

Additional Occupant Name

First Last

Additional Occupant Name

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Lived at Current Address From*

Reason for Leaving*

Current Landlord's/Manager's Name*

First Last

Landlord's Phone Number*

Rent Amount Paid Currently $*

Security Deposit $*

Previous Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date Lived at From

Date Lived at Until

Reason For Leaving

Previous Landlord Name

First Last

Landlord Phone Number

Rent Amount at Previous Address $

Security Deposit Amount at Previous Address $

Current Employment Status*

Name of Current Employer

Phone Number of Current Employer

Name of Supervisor

First Last

Phone Number of Supervisor if Different from Above

Date Employed From

Date Employed Until

Position or Job Title

Name of Previous Employer

Previous Employer Phone Number

Name of Supervisor

First Last

Supervisor Phone if Different from Above

Date Employed From

Date Employed Until

Position or Title

Your Gross Monthly Employment Income (Before Deductions)*

Average Monthly Amounts of Other Income*

Specify Sources of Additional Income

Total Amount of Monthly Income

Do You Smoke?*

Have You Ever Filed for Bankruptcy?

Have You Ever Been Sued?*

Have You Ever Been Evicted?

Have You Ever Been Convicted of a Crime?*

Explain any Instance(s) of Criminal Convictions

Reference Name*

First Last

Professional Reference Preferred (Supervisor/Boss)

Relationship with Reference*

Phone*

Best Time To Contact Reference

: HH

MM

Reference's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Second Reference Name*

First Last

Relationship With Second Reference*

Phone Number of Second Reference*

Address of Second Reference*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name*

First Last

Relationship with Emergency Contact*

Emergency Contact Phone Number*

Address of Emergency Contact*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Second Emergency Contact

First Last

Relationship with Second Emergency Contact

Phone Number of Second Emergency Contact

Address of Second Emergency Contact

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Where Did You Learn of This Vacancy?*

I certify that all the information given above is true and correct and understand that my lease or rental agreement may be terminated if I have made any material false or incomplete statements in this application I authorize verification of the information provided in this application from my credit sources, current and previous landlords and employers, and personal references. I give permission for the landlord or its agent to obtain a consumer report about me for the purpose of this application, to ensure that I continue to meet the terms of the tenancy, for the collection and recovery of any financial obligations relating to my tenancy, or for any other permissible purpose. (State I agree in field below to proceed)*

Applicant Signature (type in)*

First Last

Date Signed*