Applicant Information

Current Address Information

Previous Address Information


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


Employment Information


Additional Income

Emergency Contact

Automobile Information

Vehicle 1

Vehicle 2


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.


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.

“Angela R. White and Susquehanna Realty Management LLC have managed the Frederick Street Lofts located at 402 West Frederick Street in Lancaster since we purchased the eleven apartment cooperative complex in 2006. Angela and her staff have consistently demonstrated a high level of professionalism and expertise both in their dealings with coop occupants as well as with overall management and financial matters. As absentee owners who depend on Angela's expert advice and knowledge of the Lancaster market, we have repeatedly benefited from her sound counsel. We categorically endorse Angela R. White and Susquehanna Realty Management LLC.”

— Frederick Street Lofts, LLC — Robert L. Villanella, Ph.D., Member — Alessandro G. Villanella, Esp., Member

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