- trust the wisdom of the grasshopper -

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.

  • The security deposit is due upon execution of the lease.

  • First and last month’s rent is due on or before your move-in date.

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.

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