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Please fill out the following form completely so that we can process your application. (all information is required)

1. Applicants

Name:

Occupation:

Address Line 1:

Address Line 2:

City:

State:

Zip:

Date of Birth:
 / / (mm/dd/yy)

Social Security Number:

Spouse's Name:

Spouse's Date of Birth:
 / / (mm/dd/yy)

Spouse's Social Security Number:

Phone:

Children's Names and Ages:

Pets: Yes   No

 

2. Last Three Residences

Present Address:

Apt. #:

Date of Occupancy:

Landlord's Name:

Landlord's Address:

Landlord's Phone:

Previous Address:

Apt. #:

Date of Occupancy:

Landlord's Name:

Landlord's Address:

Landlord's Phone:

Previous Address:

Apt. #:

Date of Occupancy:

Landlord's Name:

Landlord's Address:

Landlord's Phone:

3. Employment

Present Employer:

Employer Address:

Employer Phone Number:

Dates of Employment:

Average Monthly Income:

Please enter price range:

Are you currently working with a Palermo Realty representative?:
YesNo

Select Representative:

By clicking the submit button below, I CERTIFY THAT the above information supplied is true and complete to the best of my knowledge. I authorize verification of all information given; and understand that additional information will be obtained from the Apartment Association of Northwestern Pennsylvania, Inc., the Credit Bureau, and other sources.  I understand that my rent payment record, my performance of rules and lease obligations, and my treatment of the premises will be reported to the Apartment Association of Northwestern Pennsylvania, Inc., the Credit Bureau, and other Landlords.

I understand that this application may be accepted or rejected at the discretion of the Landlord.  I understand and agree that rents and deposits paid toward the rental unit will be refunded only if this application is rejected by the Landlord; and that otherwise, those rents and deposits will be applied as specified in the lease agreement.

    

 

Rental Office: 3435 West Lake Rd
Phone: (814) 835-6757
e-mail us: info@joepalermo.com