Rental Application

We require a $35 non-refundable fee payable to Kenneth Carroll Real Estate in order to process this application. (An additional application and $25 non-refundable fee is required
for each additional prospective adult tenant).

If your current and previous employers charge for employment verification, you are responsible for providing such verification in writing from your employers, at your expense.

Section 1 - Information Required For Credit Report:
Apartment or house applied for:
Applicants Name:
Applicants Birth date:
Driver's License Number:
Social Security #:
Current Address:
Current City:
Current State
Current Zip
Previous Address:
Previous City:
Previous State:
Previous Zip:
Voice #:
Fax #:
Email Address:
Section 2 - Present Housing Information:
Present landlord or agent:
Present landlord/agent address:
Present landlord/agent phone #:
Previous landlord or agent:
Previous landlord/agent address:
Previous landlord/agent phone #:
Reason for moving from present address:
Present rent:
Rent paid to what date:
Section 3 - Employment Record and other Income Sources
Present employer:
Employer's Address:
Length of Employment:
Employer's Phone #:
Position:
Salary:
Previous employer:
Previous Employer's Address:
Length of Employment:
Previous Employer's Phone #:
Previous Position:
Previous Salary:
Section 4 - References and third party names and addresses
Bank reference 1 (Bank & Acct #):
Bank reference 2 (Bank & Acct #):
Personal reference 1:
Personal reference 2:
Personal reference 3:
In case of emergency notify 1:
In case of emergency notify 2:
Rental Consumer Notice: This is not a contract Kenneth Carroll hereby states that with respect to the rental properties (235 S. 21st Street, 2101 Spruce Street, 1084 Hollow Road, and 210 Byers Road), I am acting in the following capacity: OWNER/LANDLORD OF THE PROPERTY With respect to all other rental properties Kenneth Carroll Real Estate is acting in the following capacity: AS AUTHORIZED AGENT OF THE OWNER(S)

I certify the above information is correct and complete and hereby authorize you to make any inquiries you feel necessary to evaluate my tenancy. If I rent the unit, I understand that the information contained on this form may be maintained in a tenant database for up to five (5) years after I vacate the premises.

I hereby deposit one month's rent as earnest money to be refunded to me if this application is not accepted within five business banking days. Upon acceptance of this application, this deposit shall be retained as the security deposit. When so approved and accepted I agree to execute a lease for twelve months or longer (or shorter with the prior written approval of landlord) before possession is given. At the signing of the lease, I also agree to pay the first month's rent and last month's rent as required. If this application is not approved and accepted by the owner or the agent, the deposit will be refunded, and the applicant hereby waives any claim for damages for non-acceptance.

Return by facsimile transmission (FAX) of this application bearing the signature(s) of the applicant(s) shall constitute a duly executed release by the applicant, for the Agent to obtain all the above information and use it for the purposes for which the application is submitted. In addition, I agree to conduct real estate transactions electronically pursuant to the Pennsylvania Electronic Transactions Act.

I acknowledge Receiving The EPA Documents
"Protect Your Family From Lead in Your Home"
Required for housing built pre-1978,
"A Brief Guide to Mold, Moisture, and Your Home,"
The State Required Consumer Notice,
and For Philadelphia Tenants:
"Partners For Good Housing" Brochure

Applicant's signature ____________________________
Date__________________________________________

print and fax this application to 610-827-9286
or send it to 1565 Hollow Road - Suite 85 - Birchrunville PA 19421