Last Name *

First Name *

Middle Initial *

Drivers License #*

Birth Date (MM/DD/YYYY) *

Home Phone *

Cell Phone *

Email Address *

Street Address *

City *

State *StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington, D.C.West VirginiaWisconsinWyoming

Zip *

Date In *

Date Out *

Landlord Name *

Landlord Phone*

Monthly Rent *

Reason for Leaving *

Street Address *

City *

State *StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington, D.C.West VirginiaWisconsinWyoming

Zip *

Date In *

Date Out *

Landlord Name *

Landlord Phone*

Monthly Rent *

Reason for Leaving *

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

Do you have any pets?SelectYesNo

If yes, describe

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

1. Name *

Address *

Phone *

Relationship *

2. Name *

Address *

Phone *

Relationship *

1. Name *

Address *

Phone *

Relationship *

2. Name *

Address *

Phone *

Relationship *

Have you ever filed for bankruptcy? SelectYesNo

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

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

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

Have you ever been convicted of a crime?SelectYesNo

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

Make & Model*

Year *

License No. *

State *StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington, D.C.West VirginiaWisconsinWyoming

Make & Model

Year

License No.

State StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington, D.C.West VirginiaWisconsinWyoming

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.
— Select —R2617 Bedford Street, Apt #5, Johnstown, PA (Geistown Borough)830 Vickroy Ave, #2, Johnstown, PA 15905 (Ferndale Borough)715 Cypress Ave, Apt A, Johnstown, PA614 Park Ave, Johnstown, PA 15902559 Coleman Ave, Apt 2, Johnstown PA32 Clover St, Johnstown, PA237 R Fairfield Ave, Johnstown PA1163 A Barnett Street, Johnstown, PA

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.

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