Instructions: Please fill out the following form, print it, sign it and fax
it to us at 215-561-5536
Personal Information:
Name:
Cell #:
Birthdate:
SSN:
M/F:
Spouse:
Cell #:
Birthdate:
SSN:
E-Mail:
Marital Status:
Single
Married
Divorced
Separated
Widowed
Additional Occupants in Apartment:
Name:
Cell #:
Age:
Relationship:
Name:
Cell #:
Age:
Relationship:
Current Residence:
Street:
Apt/Suite:
City:
State:
Zip:
Country:
Phone:
How long?
Rent:
Landlord's Name:
Landlord's Phone:
Previous Residence:
Street:
Apt/Suite:
City:
State:
Zip:
Country:
Phone:
How long?
Rent:
Landlord's Name:
Landlord's Phone:
Reason for Moving:
Permanent/Parent's Residence (i.e., for students):
Street:
Apt/Suite:
City:
State:
Zip:
Country:
Phone:
Employment:
Employer/School:
Supervisor:
Street:
City:
State:
Phone:
Occupation:
Income:
How long?
Spouse's Employer:
Supervisor:
Street:
City:
State:
Phone:
Occupation:
Income:
How long?
Graduate Studies:
School Attending:
How long?
Graduate Program:
Level:
Year Graduating:
Banking Information:
Bank Name 1:
Account Type:
Bank Name 2:
Account Type:
Reference (Other than a relative):
Name:
Phone:
Address:
Credit Cards:
Company/Bank 1:
Card Type:
Company/Bank 2:
Card Type:
Car Information:
Will you have a car?:
License Plate #:
Year, Make, Model, Color:
Referred By:
Phone:
Address:
Have you or anyone who is included in this apartment rental application
ever been:
- Evicted from any residential or business occupancy?
Yes
No
- The owner of real estate which was foreclosed?
Yes
No
- Convicted of a felony?
Yes
No
- Placed under a restraining order?
Yes
No
- Is your personal property encumbered by judgment or lien?
Yes
No
If your answer is "Yes" to any of the above questions, please explain below:
We understand that waterbeds are not permitted and keeping pets is prohibited without specific
advance written approval and agree that we will not maintain or keep pets or waterbeds while we
are occupants of 2400 Chestnut Street. We further understand that failure to comply herewith
shall constitute a lease violation.
If applicant has misstated the number of persons in family or the number of persons intended
to occupy the apartment or if applicant(s) made any misstatements of fact in this application,
2400 Chestnut Associates may reject the application and retain as liquidated damages, for the
reasons set forth, all monies paid pursuant to this application. Any such misstatement shall
also constitute a breach of a lease entered into pursuant to this application.
Applicant(s) represent(s) that no real estate broker or any other person is entitled to any
commission whatsoever for this rental.
If application is accepted, leases for the apartment designated, ready for signature, will be
available to applicant(s) at 2400 Chestnut Street rental office. Applicant agrees to sign the
said lease within ten days after date of notice of approval and pay the balance due for
security deposit and first month's rent plus whatever other monies may be due.
Applicant further agrees that 2400 Chestnut Street Associates may retain, as liquidated damages,
monies paid pursuant to this application, in the event that applicant fails to execute said
lease within the ten day period. In the latter event, 2400 Chestnut Associates acceptance of
this application shall be automatically withdrawn and leases shall be deemed null and void.
Applicant(s) hereby authorizes the agents of 2400 Chestnut Associates to make investigation as
to applicant(s) character, reputation, credit, personal characteristics, and mode of living. The
nature of any investigation will be furnished upon applicant's written request within a
reasonable time. Said investigation will be without charge to applicant if application is
approved.
Applicant(s) intends to be legally bound hereby.
Applicant Signature
Date
Applicant Signature
Date
- All applicants must provide proof of identification (photo I.D.)
- Proof of employment and/or verification of graduate school is required