| JABCO REALTY MANAGEMENT, LLC RENTAL APPLICATION |
CONSUMER NOTICE
Beatrice Jabco (Licensee) hereby states that with respect to this property (describe property) ____________
___________________________________, I am acting in the following capacity:
_____ Owner/Landlord of the Property
_____ A direct employee of the Owner/Landlord: OR
__X__ An agent of the Owner/Landlord pursuant to a property management or exclusive leasing agreement.
I acknowledge I have received this notice: _______________________________________________
Consumer Date
_______________________________________________
Consumer Date
I acknowledge I have provided this notice: _______________________________________________
License
Application/Credit Report Fee: $35.00
The undersigned hereby makes an application to rent unit #______________ located at:____________________________________.
Anticipated move in date of ___________________at a monthly rent of $_______________ and security deposit of $_______________.
PLEASE TELL US ABOUT YOURSELF
Full Name_______________________________________________ Home Phone ( ) ________________________
Date of Birth_________________________________ Social Security # ____________________________________
Email Address:________________________________________(optional) Other Phone ( ) ___________________
Co-Applicant Name_________________________________________ Names of other persons who will occupy property
________________________________________________________________________________________________
Co-Applicant Date of Birth______________________ Social Security #_______________________________________
List All Pets_______________________________________________________________________________________
RESIDENTIAL HISTORY
Current Address_______________________________Apt#________ City__________________ State______ Zip________
Month/Year Moved In______________________ Reasons for Leaving________________________________________
Rent $__________
Owner/Agent_______________________________________________Phone ( ) ____________________________
CREDIT HISTORY
Have you declared bankruptcy in the past seven (7) years? Yes___________ No____________
Have you ever been evicted from a rental residence? Yes___________ No____________
Have you had two or more late rental payments in the past year? Yes___________ No____________
Have you ever willfully or intentionally refused to pay rent when due? Yes___________ No____________
EMPLOYMENT INFORMATION
Your Status: _____Full Time _____Part Time _____Student _____Unemployed
Employer_________________________________________________________________________________________
Dates employed_______________________________ Employed as__________________________________________
Supervisor Name______________________________________________ Phone ( )_________________________
Salary $_________________per________________.
If you have other sources of income that you would like us to consider, please list income, source, and person (banker, employer, etc.) who we may
contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this
application.
Amount $___________________ Source/Contact Name__________________________________________________________
REFERENCES
Personal Reference or Emergency Contact:
Name _______________________ Address _______________________________________________
Phone _______________________ Relationship_______________________
Driver's License:
Your Driver's License Number________________________ State_________________
Vehicle Information:
Make / Model _________________Year _________________License Plate State_________________
CONDITIONS OF APPLICATION AND AGREEMENT TO LEASE
This deposit paid by applicant will be held in an Escrow Account at Citizens Bank – Account Number 6201781807 located in Bellefonte, PA, as a
Security Deposit until such time as the lease is terminated and the premises is vacated. The cost of necessary cleaning, repairs or replacements
shall be deducted from the Security Deposit at termination of the lease.
THIS IS A LEGALLY BINDING OFFER TO ENTER INTO A LEASE AGREEMENT FOR THE PREMISES ON THE FORM IN CURRENT USE BY JABCO
REALTY MANAGEMENT AND CONTAINING THE ABOVE TERMS. I UNDERSTAND THAT I AM OBLIGATED TO EXECUTE SUCH A LEASE AFTER IT
HAS BEEN TENDERED TO ME. If I refuse to execute such a lease, Jabco Realty Management will make reasonable efforts to relet the premises on
my behalf. If Jabco Realty Management is successful, I understand and agree that the said deposit will be forfeited and retained as liquidated
damages by Jabco Realty Management for its efforts in processing this application, holding the premises open on my behalf pending approval of
this application, and making the necessary investigation of my character and reputation. However, until such time as Jabco Realty Management is
able to relet the premises, I understand and agree that I shall remain liable for the monthly rental payments and other charges imposed in
accordance with the terms of the proposed lease, which is agreed to be binding whether executed by me or not. No agreement except contained
herein will bind applicant, agent, or owner.
I agree and understand that the lease I will be signing is a JOINT AND SERVERAL Lease. This means all Tenants and Guarantors hold joint liability
for the entire amount due on the lease, as well as, the care and condition of the premises. I understand that in the event that one or more tenant(s)
fail to make good on their obligation that the remaining tenant(s) will be held legally responsible.
I WARRANT THAT THE ABOVE INFORMATION IS TRUE AND CORRECT AND AGREE TO THE TERMS AND CONDITIONS PRINTED ON THIS
APPLICATION. BY THE SIGNING OF THIS RENTAL APPLICATION, I AUTHORIZE JABCO REALTY MANAGEMENT TO MAKE ANY INVESTIGATIONS
ON MY BEHALF, WHICH MAY INCLUDE: CHARACTER REFERENCES, BANK REFERENCES, PRIOR RENTAL VERIFICATIONS, CREDIT HISTORY,
EMPLOYMENT HISTORY AND INCOME VERIFICATIONS.
SIGNED:_____________________________________________________ DATE:______________________________
APPLICATION ACCEPTED BY:_______________________________________________________
Jabco Realty Management
113 South Spring Street, Suite 2, Bellefonte, PA 16823
Phone: 814-355-2021 Fax: 814-355-5777 Email: Jabco Realty@aol.com
www.jabcorealty.com
