Rental Application

Resident Information

Property Applied For *

Address Line 1

Address Line 2

City

State

Zip Code

Requested Move-In Date *//

Will there be any pets in the home? *

Do any occupants smoke? *

List NAMES AND AGES of ALL Occupants (Including Applicants and children) *

Would you like to add another Applicant to this agreement? *

Every person who wishes to be on the lease needs to fill out an application. We will ask for Applicant 1's information first, then at the end Applicant 2's information will be requested.

Have you ever rented from Antietam Realty in the past? *

Yes
No

Applicant 1 Information

Applicant 1 Name *

First

Last

Applicant 1 Driver's License # *

Please upload a CLEAR picture of your Photo ID.

Click or drag a file to this area to upload.

Applicant 1 Social Security # *

Numbers only, no dashes.

Applicant 1 Date of Birth *//

Applicant 1 Cell Phone Number *

Applicant 1 Secondary Phone Number

Applicant 1 Email *

Applicant 1 Emergency Contact Information

Emergency Contact Name *

First

Last

Phone *

Relationship to Applicant 1 *

Applicant 1 Prior Tenancy Information

Applicant 1 Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you rent or own? *

Rent
Own

Monthly Payment *

Approximate Occupancy Date *//

Approximate End Occupancy Date *//

Applicant 1 Previous Address *

Address Line 1

Address Line 2

City

State

Zip Code

Did you rent or own? *

Rent
Own

Monthly Payment *

Approximate Occupancy Date *//

Approx. End Occupancy Date *//

Applicant 1 Employment Information

Are you currently employed? *

Yes
No

Applicant 1 Current Employment Information

Applicant 1 Previous Employer Information

Applicant 1 Previous Employer *

Previous Employer Address *

Address Line 1

Address Line 2

City

State

Zip Code

Previous Employer Phone Number *

Approx. Start Date *//

Approx. End Date *//

Occupation/Title *

Applicant 1 Other Income

Other Income (List source and monthly amount)

Alimony, child support, or separate maintenance income need not be revealed if Applicants do not wish to have it considered as a basis for paying this obligation.

Applicant 1 Bank Account Information

Applicant 1 Banking Institution *

Account Type *

Balance *

Would you like to provide additional account information? *

Providing additional banking information allows us to make a better-informed decision about your ability to pay this obligation.

Applicant 1 Other Obligations

To help us determine if this property is right for you, please list your current monthly obligations.

Lender Name

Loan Type

Total Balance Due

Monthly Payment Amount

Would you like to list another obligation?

If there are any other monthly obligations you would like us to know about, please list them here.

Applicant 1 Vehicle Information

Please list information for your vehicles. Remember, other applicants will be asked to provide this information as well.

Make/Model *

Year *

Color *

State/License Plate Number *

Would you like to list another vehicle? *

Applicant 1 Final Questions

Why are you moving? *

Do you have any outstanding judgements? *

Yes
No

Have you in the last 7 years declared bankruptcy, suffered foreclosure, had an account assigned for collection, or had any legal action affecting ability to finance? *

Yes
No

Have you been more than 7 days late in making your rental/mortgage payments in the last 3 years? *

Yes
No

Have you at any time since January 1, 1998 been obligated to pay support under an order that is on record in any Pennsylvania county? *

Yes
No

Have you ever been convicted of a crime? *

Yes
No

Legalese and Disclaimers

READ CAREFULLY IN ITS ENTIRETY

Civil Rights Acts

Federal and state laws make it illegal for a landlord, broker, or anyone to use RACE, COLOR, 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 OF 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 reasons for any decision relating to the sale or lease of property. It is also unlawful discriminatory practice to evict or attempt to evict an occupant of a housing accommodation before the end of the term of the lease because of pregnancy or birth of a child.

I acknowledge that I have read and understand the Anti-Discrimination laws Antietam Realty, Inc. subscribes to in housing and rental decisions. *

I acknowledge and understand the preceding information.

The undersigned Applicant(s) acknowledges that the above information is true and correct and hereby authorize Antietam Realty, Inc., Agent for Landlord/Owner, to verify the information contained herein, obtain a credit and/or criminal background report and to report the information obtained to the Landlord. Applicants acknowledge that if they present false information, Landlord may reject this application. Applicants understand that giving false or incomplete information may result in forfeiture of deposits or other financial loss.

NOTICE: A $25 NON-REFUNDABLE APPLICATION FEE PER APPLICANT IS REQUIRED WITH ALL APPLICATIONS.

If you are approved for the applied property, a ONE MONTH DEPOSIT is required to gain possession of the property. If you are approved and/or the property is held for you and a lease is not executed, THE DEPOSIT MAY BE FORFEITED EITHER ALL OR IN PART.

Name of Applicant 1 *

First

Last

Please re-type your name as confirmation of consent to pull all relevant information pertaining to this rental application.

Applicant 1: By checking this box, you are electronically signing this agreement. You agree that once the box is checked, Antietam Realty, Inc. holds consent to process this application and verify that all information is true and accurate to the best of your knowledge. Furthermore, you agree with all Terms and Conditions that have been outlined in this application. By checking this box, you further understand that without payment, this application will not be reviewed or processed. *

I agree to all terms and conditions and consent to this electronic signature substitution. (Applicant 1)

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Resident Information

Applicant 1 Information

Applicant 1 Emergency Contact Information

Applicant 2 Information

Applicant 2 Emergency Contact Information

Applicant 1 Prior Tenancy Information

Applicant 2 Prior Tenancy Information

Applicant 1 Employment Information

Applicant 1 Current Employment Information

Applicant 1 Previous Employer Information

Applicant 1 Other Income

Applicant 2 Employment Information

Applicant 2 Current Employment Information

Applicant 2 Previous Employer Information

Applicant 2 Other Income

Applicant 1 Bank Account Information

Applicant 1 Other Obligations

Applicant 2 Bank Account Information

Applicant 2 Other Obligations

Applicant 1 Vehicle Information

Applicant 2 Vehicle Information

Applicant 1 Final Questions

Applicant 2 Final Questions

Legalese and Disclaimers

Civil Rights Acts

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Rental Application

Resident Information

Applicant 1 Information

Applicant 1 Emergency Contact Information

Applicant 2 Information

Applicant 2 Emergency Contact Information

Applicant 1 Prior Tenancy Information

Applicant 2 Prior Tenancy Information

Applicant 1 Employment Information

Applicant 1 Current Employment Information

Applicant 1 Previous Employer Information

Applicant 1 Other Income

Applicant 2 Employment Information

Applicant 2 Current Employment Information

Applicant 2 Previous Employer Information

Applicant 2 Other Income

Applicant 1 Bank Account Information

Applicant 1 Other Obligations

Applicant 2 Bank Account Information

Applicant 2 Other Obligations

Applicant 1 Vehicle Information

Applicant 2 Vehicle Information

Applicant 1 Final Questions

Applicant 2 Final Questions

Legalese and Disclaimers

Civil Rights Acts

Compare

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