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Pennsylvania Rental Application Form is a rental application applied in the state of Pennsylvania. This rental application contains the following five sections: Statement, APPLICANT INFORMATION, RESIDENTIAL INFORMATION, EMPLOYMENT INFORMATION, OTHER INCOME. There are five statements at the top of the lease. Please read the statements firstly and then read the other four sections carefully. Please fill all the spaces in the five sections.

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RENTAL APPLICATION
1. A non-refundable application fee of $____ per applicant is required when an application is submitted. All individuals
age 18 or over that intend to reside in the property must apply.
2. The applicant must provide their photo ID and proof of social security number before a showing.
3. The applicant must complete the application in full. Put N/A in any areas that do not apply.
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
4. A hold deposit equal to one month’s rent must be paid in full to hold a rental unit. A hold deposit is non-refundable 3
days after approval. NO UNIT WILL BE HELD WITHOUT A DEPOSIT.
5. The lease must be signed within ___ days of approval, or the hold deposit will be forfeited.
APPLICANT INFORMATION
Full Name _____________________________________ Is applicant at least 18 years old? c Yes c No
Social Security Number __________________________ Date of Birth _________________________________
Drivers License / ID No. _________________________ State _______________________________________
Home Phone ____________________ Work Phone ____________________ Cell Phone ____________________
Bank/Credit Union_________________________Account #___________________Account Type______________
Emergency Contact ______________________________ Relationship _________________ Phone ____________
RESIDENIAL INFORMATION
(two year history)
Current Address ___________________________________________________________ c Own c Rent
From ________________________ to ______________________ Rent/mortgage $ _______________ /month
Landlord/Mortgage Co. Name _______________________________________ Phone______________________
Prior Address _____________________________________________________________ c Own c Rent
From ________________________ to ______________________ Rent/mortgage $ _______________ /month
Landlord/Mortgage Co. Name _______________________________________ Phone______________________
EMPLOYMENT INFORMATION
(two year history)
Employer ________________________________________ Position ___________________________________
Address ______________________________________________________________________________________
Phone __________________________________________ Supervisor __________________________________
Gross Income $ ______________ /mo. OR $ _____________ /hour for __________ hours per week on average
Employed From ______________________ To ____________________
Previous Employer ________________________________ Position ___________________________________
Address ______________________________________________________________________________________
Phone __________________________________________ Supervisor __________________________________
Gross Income $ ______________ /mo. OR $ _____________ /hour for __________ hours per week on average
Employed From ______________________ To ____________________
OTHER INCOME
Alimony, child support, or separated maintenance income need not be revealed if Applicant does not wish to have it considered as a basis for paying this obligation.
Source ____________________________________________________________ Amount __________________
Source ____________________________________________________________ Amount __________________
Applicant Initials ____________________Date________________
LPM 106a-042011
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Pennsylvania Rental Application Form
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