Rental Application - Capozzi Real Estate/Insurance

Transcription

BARBARA A. CAPOZZI, ESQ.
3320 South 20th Street
Philadelphia,
Tel: 215.551.5100
Fax: 215.551.5230
Email: [email protected]
*
Real Estate/Insurance,
Ltd.
*
PA 19145
RENTAL APPLICATION
NON-REFUNDABLE CREDIT REPORT FEE $ 50.00
SUBJECT PREMISES
1. Location
of Premises
2. Rental Term to Commence
3. Term of Rental
_
4. Monthly Rent
5. Deposit Received
_
_
APPLICANT INFORMATION
6. Applicant Name
_
7. Current Address
---------------------
8. Telephone #
Home
9. Birthdate
Cell
__________
Work
Birthplace
10 Social Security #
_
_
Driver's License #
APPLICATION WILL NOT BE PROCESSED WITHOUT A CLEAR XEROX
COpy OF DRIVER' LICENSE, SOCIAL SECURITY & 2 CURRENT
PAYSTUBS.
11 List ALL Household Members who will live in rented premises.
Name
Age
Occupation/School
RARL
RENTAL APPLICATION
This form recommended
FOR REPRESENTED
LANDLORDS
and approved for, but Dot restricted to use by, the members of the Pennsylvania Association of REALTORS®
(PAR).
The following box should be completed only when the real estate licensee represents the landlord, is a direct employee of the landlord or owns the property. This box should not be completed when licensee is subagent for the landlord, a tenant agent or is a transaction licensee. If it should not be completed the full Consumer Notice should be completed and the applicant should proceed to the
section below this box.
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CONSUMER NOTICE FOR TENANTS
THIS IS NOT A CONTRACT
7
(Licensee)J.._
8
____........
.----;-:,..-::::__-=__=---;-~.,...--=-----,-------------- , I am acting in the following capacity: (check one)
0
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0
11
I&J
--=B:!:a:::r:=b::.::a:.::r:..::a:::........:C::.:a:.Jp:::.;o:::.z=z::.i~E.:::S~g..:..
hereby states that with respect to this property (describe property)
(i) Owner/Landlord of the Property;
(ii) A direct employee of the Owner/Landlord; OR
(iii) An agent of the OwnerlLandlord pursuant to a property management or exclusive leasing agreement.
12 I acknowledge that I have received this Notice:
13 Drue:
•
~~~----~----------14
Print (Consumer)
15 I certify that I have provided this Notice:
Barbara
Capozzi
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(Licensee)
17
BrokerfLicensee
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Pa.
Company Phone ....,(..:::2.;:;:1..:::57-)
..:::5-=571_--=51:::-0~0-:Company Fax
....l(~2~l:..:5:..!.)-=5-=5~1'---=5-=2:..:3:...:0:...._
__
_
Broker (Company) Capozzi
Real
Estate/Insurance
~L~t~d~.
Company Address 3320 s. 20th Street
Philadelphia,
Property
_
_
551-
5100
___
for Tenant
Capozzi
DirectPhone(s) (215)
551-5100
Cell Phone( s)
Fax
(215)
551-5230
Email [email protected]
(to be completed by Broker for Landlord)
Address
Move-in Date --:-=---:--:-:--:-::-_
Application Fee (non-refundable) $ =5-"0..:..-"0-"0
_
Monthly Rent $
First Month's Re-nt-$=------------------------------Are pets permitted? ( DYes) ( I[J No) May be subject to review.
Non-refundable Pet Fee $
~------------Other
$ ---c"....,..-:;:--:-::-:---Is rental insurance required for-tenants? ( I[J Yes) (0 No)
Rent and Security Deposit checks will be written separately.
·42
(215)
Licensee(s) (Name) Barbara
19145
Information
Direct Phone(s)
Cell Phone( s)
Fax
Email
__
Company Phone ..,(:=2:..:1:..::5'7)...::5:..:::5:..:::1:....-...::5:..:::1:..::0:..::0'-Company Fax
....l(c=2~1:..:5..!..)
..::5..::5.=1_-.:::.5.:::.2.:::.3.::..0
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Pa.
_
_
BrokerfLicensee
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(Date)
for Landlord
19145
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Esq.
Licensee(s) (Name) _B_a_rb
__ar_a
__ c_a_:p'-o_z_z_i
Broker (Company) Capozzi
Real
Estate/Insurance
=L~T~D~.
Company Address 3320 s. 20th Street
Philadelphia,
~~--~~----~-----------I
Signed (Consumer)
Term~:--~--~-=---------------------------Application Deposit $
Security Deposit $ ;:-Last Month's Rent $
Pet Rent $
Other
__
_
_
___
$
_
How did you hear about the property?
43
Applicant's Initials __
__
RARL Page 1 of 4
~ I Pennsylvanla Association
of REALTORS'
COPYRIGHT
PENNSYLVANIA
ASSOCIATION
OF REALTORS®
2013
1113
Capozzi Real Estate/Insurance
Phone: (215)551-5100
3320 South 20th Street Philadelphia, PA 19145
Fax:
Barbara Capozzi
Produced with zipForm® by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026
Untitled
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1.
APPLICANT INFORMATION
Provide at least two years of history. Attach additional sheets if more space is needed.
The individual listed below is a(n):
(0
Applicant)
(0 Co-signer)
FullName
Home Phone
Cell Phone
Present Address & ZIP
From
To
Landlord/Mortgage Co. Name & Phone
Previous Address & ZIP
From
To
LandlordIMortgage Co. Name & Phone
_
_
_
__
Work Phone
Email
_
_
RentIMortgage $
Imo. (0 Own) (0 Rent) (0 Other)
_
RentIMortgage $
Imo. (0 Own) (0 Rent) (0 Other)
---,_1_
Is Applicant at least 18 years old? (0 Yes) (0 No)
Are you applying with anyone else? (D Yes) (0 No) A separate application
Name
(0 Applicant)
Name
(D Applicant)
Name
(0 Applicant)
Name
(D Applicant)
Will anyone else be occupying the property? (0 Yes) (0 No)
Include the full name of any other person not listed above who will be occupying
Name
0 18 or older
Name
D 18 or older
Name
D 18 or older
Name
0 18 or older
Check here if additional information is attached
must be completed for each applicant/co-signer.
(0
(0
(D
(0
Co-signer)
Co-signer)
Co-signer)
Co-signer)
the property.
o
2. EMPLOYMENT INFORMATION
Provide at least two years of history. Attach additional sheets if more space is needed.
Employer
Employed From
To
_
CitylState
Phone
Supervisor
Position
Gross Income: $
Imo. OR $
Ihr., for __
Previous Employer
EmployedFrom
CitylState
Supervisor
To
hrs. per week (on average)
_
_
Phone
Position
Gross Income: $
Proof of income attached
Check here if additional information
o
o
Imo. OR $
Ihr., for __
..>...,_
_
hrs. per week (on average)
is attached
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3. OTHER INCOME USED FOR MONTHLY EXPENSES
Alimony, child support, or separate 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
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4. BANK ACCOUNT INFORMATION
Bank Name
94
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0
is attached
Account Type
Balance
$
$
_
_
$
_
0 Check here if additional information is attached
Applicant's
Initials
__
RARL Page 2 of 4
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18070 Fifteen Mile Road, Fraser, Michigan 48026
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Untitled
-A_pplicant name
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5.
MONTHLY
0
PAYMENTS
Lender Name
Loan Type
Balance Due
$
$
$---------$----------
$ --------
$ ------
$
$----------
is attached
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6. VEIDCLE
Include any cars, trucks, vans, motorcycles, trailers, boats and recreational vehicles.
MakelModel
Year
Color
III
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7. PETS
Does any Applicant or Occupant own any pets?
Pet 1
Type (Cat, dog, etc.)
Breed
Age
Weight
Gender
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8. OTHER INFORMATION
(0 Yes) (0 No) Have you ever declared bankruptcy or suffered foreclosure?
If yes, list any payments: $
_
(0 Yes) (0 No) Have you ever defaulted on your mortgage?
(0 Yes) (0 No)
Have you been evicted or sued for unpaid rent or damages to leased property?
(0 Yes) (0 No)
Have you ever refused to pay rent for any reason?
( 0 Yes) (0 No)
Have you ever been convicted of or entered a plea of guilty or nolo contendere for a felony or misdemeanor?
(0 Yes) (0 No)
Since January 1,1998, Have you been obligated to pay support under any order(s) of record? If yes:
County
Domestic Relations File or Docket Number:
_
Amount
Are you delinquent?
__
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If you answered "yes" to any of the above questions, please explain:
0
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9. CONDITION OF PROPERTY
The Property will be leased in the same condition as it is shown unless otherwise agreed to in writing.
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10. APPLICATION FEE
The Application Fee is NON-REFUNDABLE and will not be applied towards rent or other financial obligations should
Applicant be approved, nor refunded if not approved. Applicant agrees that this sum is paid in consideration of
LandlordlBroker for Landlord's review andiorverifIcation of the information stated in the application.
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11. OBLIGATION TO ENTER INTO LEASE AGREEMENT/ DAMAGES
Upon submission of this Application, Landlord/Broker for Landlord reserves the right to remove property from the available
rent list. If this Application is denied by Landlord, the Application Deposit shall be refunded to Applicant. If this Application
is approved and Applicant fails to rent the Property, Landlord shall be entitled to retain the Application Deposit.
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12. CONVICTED SEX OFFENDERS (MEGAN'S LAW)
The Pennsylvania General Assembly has passed legislation (often referred to as "Megan's Law," 42 Pa.C.S. § 9791 et seq.)
providing for community notification of the presence of certain convicted sex offenders. Potential tenants are encouraged
to contact the municipal police department or the Pennsylvania State Police for information relating to the presence of
sex offenders near a particular property, or to check the information on the Pennsylvania State Police web site at
www.pameganslaw.state.pa.us.
149
0
Applicant's Initials __
-:
License Plate/State
is attached
(0 Yes) (D No) If yes, provide detail below.
Pet 2
Pet 3
is attached
RARL Page 3 of 4
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"
Monthly Payment
www_zipLogix_com
Untitled
=,
Applicant name
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13. NOTICE TO PERSONS OFFERING TO SELL OR RENT HOUSING IN PENNSYLVANIA
Federal and state laws make it illegal for Landlord, Broker, or anyone to use RACE, COLOR, RELIGION or RELIGIOUS
CREED, SEX, DISABILITY (physical or mental), FAMILIAL STATUS (children under 18 years of age), AGE (40 or older),
NATIONAL ORIGIN, USE OR HANDLING/TRAINING OF SUPPORT OR GUIDE ANIMALS, or the FACT OR RELATIONSHIP OR ASSOCIATION TO AN INDIVIDUAL KNOWN TO HAVE A DISABILITY as reasons for refusing to sell,
show, or rent properties, loan money, or set deposit amounts, or as reasons for any decision relating to the sale of property.
The municipality in which the Property is located may have enacted an ordinance or other law that extends the protections for
access to housing to additional classes of individuals, such as gay, lesbian, bisexual and transgender individuals and couples.
Broker and Landlord are advised to check with your local municipality, representative from the Pennsylvania Human
Relations Commission, or your own attorney for further guidance.
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14. FAIR CREDIT REPORTING ACT
If the Landlord or Broker denies your application based in whole or in part on any information contained in the consumer report authorized by paragraph 16 of this Application, the Landlord or Broker must provide you with oral, written or electronic notice of the denial,
and must provide to you: (1) the name, address, and telephone number of the consumer reporting agency (including a toll-free te1ephone number established by the agency if the agency compiles and maintains files on consumers on a nationwide basis) that furnished
the report, (2) a statement that the consumer reporting agency did not make the decision to deny the application and is unable to provide you with the specific reasons why your application was denied, (3) a numerical credit score, the range of possible credit scores
under the model used, up to four of the key factors that led to the denial, and the date the credit score was created (4) information about
how to obtain a free copy of your consumer report from the consumer reporting agency, and (5) information about how to dispute the
accuracy.or completeness of any information in a consumer report furnished by the agency. If the Landlord or Broker denies your application because of information from a person other than a credit reporting agency (for example, an employer or prior landlord), the
Landlord or Broker must provide you with notice about your right to make a written request to discover the nature of that information.
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15. SPECIAL CLAUSES
(A) The following are part of this Application if checked:
0 Advanced Payment Addendum (PAR Form APA)
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16. AUTHORIZATION
By initialing below, Applicant provides the described authorization.
Applicant authorizes Landlord or Broker for Landlord to obtain any information deemed necessary to evaluate this
Application. This information may include, but is not limited to, credit reports, criminal history, judgments of record,
rental history, verification of employment and salary, employment history, vehicle records, and licensing records.
Broker for Landlord may report to Landlord any information obtained by Broker for Landlord for evaluation of the
Application. Applicant acknowledges that all information in the Application is true and correct. Applicant acknowledges that if applicant presents false or incomplete information Landlord may reject this Application. Applicant
understands that giving false or incomplete information may result in forfeiture of any payments made in connection
with this Rental Application.
0
0
(B) Additional Terms:
_
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Applicant authorizes the Broker for Owner to contact the Applicant directly.
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Applicant agrees that Broker(s), hislher 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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For Tenant Identification
200
Social Security NumberllTIN
201
Driver's License/Government ID Number
202
I HAVE READ AND AGREE TO THE PROVISIONS
203
APPLICANT
SIGNATURE
204
APPLICANT
NAME
Purposes Only
_
Date of Birth
-----~---------_
_ Driver's License State
AS STATED.
_ DATE
_
DATE
__
RARL Page 4 of 4
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18070 Rfteen Mile Road, Fraser, Michigan 48026
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->.
Applicant name
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14. FAIR CREDIT REPORTING
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15. SPECIAL CLAUSES
0 Advanced Payment Addendum (PAR Form AP A)
ACT
and must provide to you: (1) the name, address, and telephone number of the consumer reporting agency (including a toll-free telephone number established by the agency if the agency compiles and maintains files on consumers on a nationwide basis) that furnished
accuracy or completeness of any information in a consumer report furnished by the agency. If the Landlord or Broker denies your application because of information from a person other than a credit reporting agency (for example, an employer or prior landlord), the
0
0
(B) Additional
Terms:
_
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16. AUTHORIZATION
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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
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Social Security NumberlITIN
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APPLICANT
SIGNATURE
204
APPLICANT
NAME
Purposes Only
_
Date of Birth
----~----------_
AS STATED.
_
DATE
_
DATE
_
RARL Page 4 of 4
Produced
with zipForm®
by zipLogix
18070 Fifteen Mile Road, Fraser, Michigan 48026
www.zipLogix.com
Untitled
, Applicant name
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14. FAIR CREDIT REPORTING
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15. SPECIAL CLAUSES
0 Advanced Payment Addendum (PAR Form AP A)
ACT
and must provide to you: (1) the name, address, and telephone number of the consumer reporting agency (including a toll-free telephone number established by the agency if the agency compiles and maintains files on consumers on a nationwide basis) that furnished
accuracy "or completeness of any information in a consumer report furnished by the agency. If the Landlord or Broker denies your application because of information from a person other than a credit reporting agency (for example, an employer or prior landlord), the
0
0
(B) Additional Terms:
_
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16. AUTHORIZATION
'
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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
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Social Security NumberlITIN
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APPLICANT
SIGNATURE
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APPLICANT
NAME
Purposes Only
_
Date of Birth
-'-_~
_
_
AS STATED.
_ DATE
__
DATE
__
RARL Page 4 of 4
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by zipLogix
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Untitled

Rental Application - Capozzi Real Estate/Insurance

Transcription

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