RENTAL
APPLICATION
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Landlord: Jones
Hardware Application
to rent: |
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TODAY’S
DATE IS: |
Name__________________________________ |
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For
a term of 1 Year Lease, with renewal option.
Desired
date of occupancy:___________________________
Desired
length of occupancy:__________________________
Reason
for moving:_________________________________
The
monthly rent shall be $___________ payable in advance.
Garage
$____________
The
following deposits are required:
-
Security deposit of $625.00
-
Pet deposit of $$$________ Negotiable
The
total amount of $_____________including pet deposit, due upon
signature of the lease.
The
Applicant understands that the Landlord will perform a credit check to verify
the Applicant's credit references and credit history in connection with the
processing of this Rental Application.
APPLICANT INFORMATION
Name:
________________________________________________________
No.
of occupants: Adults:
_____Children: _____
Water
bed:
Yes ____ No ___
Smokers:
Yes ____ No ___
Pets:
Yes ____ No ___If so, what and how
many?_____
PRESENT
ADDRESS: ________________________________
How
long at present address: _________________________
Landlord's
Name: __________________________________
Phone
No.: (____)____________
Current
rent payment: ____________
PRIOR
ADDRESS: ____________________________________
How
long at prior address: ____________________________
Landlord's
Name: ___________________________________
Phone
No.: (____)_____________________
Rent
payment: ____________
Reason
for moving: _________________________________
Ever convicted of a crime?______If so ,what date?_____
PLEASE
CIRCLE: Single
– Married
– Divorced
- Separated
Social
Security No.: __________-_________-__________
Birth
date : ______-______-______
PA
Driver's License No. :__________________
Vehicle
Model: _____________________Year: __________
License
No.: ________________________
Vehicle
Model: _____________________Year: __________
License
No.: ________________________
SOURCES
OF INCOME:
Wages
$__________
Salary
$__________
Commission
$__________
Tips
$__________
Gov't
assistance
$__________
Child
support
$__________
Other
$__________
CURRENT
EMPLOYER:
Employer:
_____________________________________________
Position:
____________________ How
long: __________________
Supervisor:
__________________ Business Phone:
(____)________
Annual
Income:
PRIOR
EMPLOYER:
Employer:
_____________________________________________
Position:
____________________ How
long: __________________
Supervisor:
__________________ Business Phone:
(____)________
Annual
Income:________________
NEAREST RELATIVE NOT LIVING WITH YOU:
Address:______________________________
Home
Phone No.: (_____)
PERSONAL
REFERENCES:
|
Name:_______________________
|
Name:
|
BANK
REFERENCES:
Name:
____________________________________
Branch:
___________________________________
Do
you own real estate?
Yes
____ No ____
If yes, please explain where:
Have
you ever been evicted from any rental premises?
Yes
____ No ____
If yes, please explain:
Have
you ever willfully and intentionally refused to pay rent when due?
Yes
____ No ____
If yes, please explain:
Are
there any circumstances that may interrupt your income or ability to pay rent?
Yes ____ No ____
If yes, please explain:
Have
you ever been convicted of a felony?
Yes
____ No ____
If yes, please explain
Please
provide names of other tenants, including children and
anyone who will live
with you, even if on a temporary basis.
Name:
_______________________________
Birth
date: ____-____-____ PA Driver's License No. :__________
Adult:
_____ Child______ Age: _____ Relationship: ___________
Occupation:
_________________School/Grade: _____________
Name:
_______________________________
Birth
date: ____-____-_____ PA Driver's License No. :_________
Adult:
_____ Child______ Age: _____Relationship: ___________
Occupation:
_________________School/Grade : ____________
I represent that the
information provided in this Application is true and correct to the best of my
knowledge. Jones Hardware
is authorized to verify the references and
employment information given in this Application and to request a credit
check.
__________________________________________________ _________________
Applicant's
Signature
Date
________________________________________
_____________
Co-Applicant's
Signature
Date
IT IS AGAINST THE LAW TO DISCRIMINATE AGAINST
PROSPECTIVE TENANTS ON THE BASIS OF RACE, RELIGION, NATIONAL ORIGIN, AGE,
DISABILITY OR FAMILY STATUS. LOCAL
OR STATE LAWS MAY INCLUDE ADDITIONAL CLASSES WHICH ARE PROTECTED FROM
DISCRIMINATION IN HOUSING.
Fax,
email, or mail the application. The
application can be given at the time of an appointment to view the
home is scheduled.
Jones Hardware
- 4276 State RT 147 - Herndon, PA 17830
570
898 5731 cell
570-758-8822 Fax
sales@joneshardware.com
Accepted: ________ Refused:
_________