Rental Application – 814 Rentals

Applicant Information

Last Name *

First Name *

Middle Initial *

Drivers License #*

Birth Date (MM/DD/YYYY) *

Home Phone *

Cell Phone *

Email Address *

Current Address

Street Address *

City *

State *

Zip *

Date In *

Date Out *

Landlord Name *

Landlord Phone*

Monthly Rent *

Reason for Leaving *

Previous Address

Street Address *

City *

State *

Zip *

Date In *

Date Out *

Landlord Name *

Landlord Phone*

Monthly Rent *

Reason for Leaving *

Other Occupants

List names and birth dates of all additional occupants 18 years or older

List names and birth dates of all occupants 18 years or younger

Pets

Do you have any pets?

If yes, describe

Employment & Income Information

1. Occupation *

Employer/Company Name *

Monthly Salary *

Supervisor Name*

Supervisor Phone *

Start Date *

End Date

2. Occupation

Employer/Company Name

Monthly Salary

Supervisor Name

Supervisor Phone

Start Date

End Date

Emergency Contact

1. Name *

Address *

Phone *

Relationship *

2. Name *

Address *

Phone *

Relationship *

Personal References

1. Name *

Address *

Phone *

Relationship *

2. Name *

Address *

Phone *

Relationship *

Background Information

Have you ever filed for bankruptcy?

Have you ever willfully or intentionally refused to pay rent when due?

Have you ever been evicted from a tenancy or left owing money?

If yes, please provide property name, city, state, and landlord name

Have you ever been convicted of a crime?

If yes, please provide type of office, county, and state

Vehicle Information

Make & Model*

Year *

License No. *

State *

Make & Model

Year

License No.

State

Other Information

How did you hear about this property?

Please include any other information you believe would help to evaluate this application

Please select the available property you are interested in.

I/we, the undersigned, authorize Eight One Four Rentals LLC, its partners and its agents, to obtain an investigative consumer credit report including but not limited to credit history, landlord/tenant court record search, criminal record search and registered sex offender search. I authorize the release of information from previous or current landlords, employers, and bank representatives. This investigation is for tenant screening purposes only, and is strictly confidential. This report contains information complied from sources believed to be reliable, but the accuracy of which cannot be guaranteed. I hereby hold Eight One Four Rentals LLC, its owners, partners and its agents free and harmless of any liability and/or damages that could be associated with this misinterpretation or misuse of this information.

Important information about your rights under the Fair Credit Reporting Act:

You have a right to request disclosure of the nature and scope of the investigation.
You must be told if information in your file has been used against you.
You have a right to know what is in your file, and this disclosure may be free.
You have a right to ask for a credit score (there may be a fee for this service.)
You have the right to dispute incomplete or inaccurate information.

These reports are being processed by Eight One Four Rentals LLC, 2441 Bedford Street, Johnstown, PA 15904, (814) 266-9522.

A summary of your rights under the Fair Credit Reporting Act is available by visiting http://www.ftc.gov/credit

I agree.