Application

Unit Address

Applicant Information

First Name

Last Name

Date of Birth

Social Security #

Home Phone

Work Phone

Cell Phone

Current Address Information

Current Address

City

State

Zip

Move In Date

Move Out Date

Landlord/Owner Name

Landlord/Owner Phone #

Reason for Moving

Rent Amount

Previous Address Information

Previous Address

City

State

Zip

Move In Date

Move Out Date

Landlord/Owner Name

Landlord/Owner Phone #

Reason for Moving

Rent Amount

Occupants

Please note: Each occupant 18 and older will need to submit their own application.

Occupant 1

18 years or older

Occupant 2

18 years or older

Occupant 3

18 years or older

Occupant 4

18 years or older

Occupant 5

18 years or older

Occupant 6

18 years or older

Pets

I will have pets in the property I am applying for.

Type

Breed

Weight

Employment Information

Applicant

Employer

Current Gross Income

Income Frequency

Supervisor

Supervisor Phone

Start Date

Additional Income

Income 1 Type

Income 1 Amount

Income 2 Type

Income 2 Amount

Income 3 Type

Income 3 Amount

Emergency Contact

Person To Notify

Address

Phone

Relationship

Automobile Information

Vehicle 1

Make

Model

Year

Plate Number

Vehicle 2

Make

Model

Year

Plate Number

Questions

Have you ever been evicted or asked to move? If yes, please explain.

Have you ever been convicted of a felony? If yes, please explain.

Have you ever filed bankruptcy? If yes, please explain.

Consumer Notice For Tenants

THIS IS NOT A CONTRACT. (Licensee) Susquehanna Realty Management LLC hereby states that with respect to the property,we are acting in the following capacity: An agent of the Owner/Landlord pursuant to a property management or exclusive listing agreement.

Authorization

Applicant authorizes Landlord or Broker to obtain any information deemed necessary to evaluate this Application. This information may include, but is not limited to, credit reports, criminal history, judgements of record, rental history, verification of employment and salary, employment history, vehicle records, and licensing records. Broker may report to Landlord any information obtained by Broker for evaluation of the Application. Applicant acknowledges that all information in the Application is true and correct. Applicants acknowledge that if they present false or incomplete information Landlord may reject this Application. Applicants understand that giving false or incomplete information may result in forfeiture of any payments made in connection with this Rental Application.

Applicant authorizes the Broker for Owner to contact the Applicant directly.

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.

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