I have read and agree to the Application Agreement. Click Here to read Application Agreement.

CONSUMER NOTICE FOR TENANTS THIS IS NOT A CONTRACT.

Hauenstein Agency, Inc. (Licensee) hereby states that with respect to any property managed by Hauenstein Agency, Inc. I am acting in the following capacity
Owner/Landlord of the Property
A direct employee of the Owner/Landlord
An agent of the Owner/Landlord pursuant to a property management or exclusive leasing agreement

I/We hereby certify that I/we am/are at least 18 years of age, wish to rent and authorize Hauenstein Agency, Inc. to check our financial responsibility, employment record, delinquent credit applications, and/or past or present criminal records; including, but not limited to the securing of a credit report from an appropriate credit bureau.
I acknowledge that I have received this notice.
Property Information
Property Address:
Date you will take occupancy:
Click Here
Date Submitted

12-11-2017
Applicant type: Individual   Co-Applicant
Applicant Information
First:
Middle:
Last:
Date of Birth:
Click Here
SSN:
Home Number:
Cell Number:
Email:
Driver License #:
State:
Expires: Click Here
Automobile Information
Make:
Model:
Year:
Color:
License plate#:
State:

Make:
Model:
Year:
Color:
License plate#:
State:

Any other name(s) used (including maiden name): 
Residential History
Current Address
Street1:
Street2:
City:
State: Zip:
Residency: Rent   Own
Previous Address
Street1:
Street2:
City:
State:
Zip:
Residency:
Rent   Own
Employment Information
Are you Retired?
Yes No
Current Employer
Employer:
Address:
City:
State:
Zip:
Phone Number:
  Ext:
Supervisor Name:

Supervisor Number:
  Ext:

Your Title/Position:

Monthly Income:
Start Date:
Click Here
Are you Self-Employed?
Yes No
Previous Employer
Employer:
Address:
City:
State:
  Zip: 
Phone Number:
  Ext:
Supervisor Name:

Supervisor Number:
  Ext:

Your Title/Position:

Monthly Income:
Start Date:
Click Here
End Date:
Click Here
Applicant Questions
Have you ever been asked to move out of a residence?
Yes   No

Have you ever been party to an eviction or sued for unpaid rent and damages to a leased property?
Yes   No
Are you a registered sex offender?
Yes   No
Have you or any member of your household been convicted or pleaded no contest to a felony?
Yes   No


Have you at any time on or since January 1, 1998 been obligated to pay child support under an order on record in any Pennsylvania county?
Yes   No

Do you have liquid furniture? (i.e. waterbed)
Yes   No

Do you have renter insurance?
Yes   No
Have you ever filed bankruptcy?
Yes   No
Have you ever had any collections?
Yes   No
Pets
Do you have Pets?
Yes   No
Other Occupants (Type a last name then hit Tab to add another occupant.  The maximum is six.)
Please list all people who will reside in the residence:
First: MI: Last:   Relation: Date of Birth: Click Here

Emergency Contact:
First:
Middle:
Last:
Home Phone:
Cell Phone:
Street1:
Street2:
City:
State: Zip:
Nearest Relative (Not residing in the property.):
First:
Middle:
Last:
Home Phone:
Cell Phone:
Street1:
Street2:
City:
State: Zip:

Financial Information
Bank NameAccount TypePhone
Credit Reference NameAccount TypeBalance




Do you own a home or other real estate? Yes   No

Additional Income SourceMonthly Income
Pension
Social Security and/or SSI
Alimony
Child Support
AFDC/Government Assistance
Unemployment Compensation
Other
Additional Comments or Notes
Application Completion

Consumer Authorization to obtain Consumer Report

"I hereby authorize Hauenstein Agency Inc. to obtain a consumer report, and any other information it deems necessary, for the purpose of evaluating my application. I understand that such information may include, but not be limited to, credit history, civil and criminal information, records of arrest, rental history, employment/salary details, vehicle records, licensing records, and/or any other necessary information. I hereby expressly release Hauenstein Agency Inc. and any procurer or furnisher of information, from any liability what-so-ever in the use, procurement, or furnishing of such information, and understanding that my application information may be provided to various local, state and/or federal government agencies, including without limitation, various law enforcement agencies."


APPLICANT SIGNATURE: 



   
Database Name:  Residential_Rentals 112143