Rental Application

(Make check payable to:)
C.C.F.S.
P.O. Box 3940
Philadelphia, PA 19146-3940

Applicant Information

Name of Applicant: ________________________________ Phone # ____________

Birth date: ___/___/___        Sex: ____           Social Security #_____-____-_____ 

Current Address: _______________________ How Long: _____ Reason for Leaving: ______________

Current Landlord: _______________ Address: _______________________Phone # ______________

Previous Address: _____________________ How Long: ____ Reason for Leaving: ________________

Previous Landlord: ______________ Address: _____________________Phone #_________________

Date you are available to move in?_______________________________________  

Name of Co-Applicant:____________________  Other Occupants Names: ______________________

Number of Dependents: _____ Ages: ___________  Any Pets? ________________________________

Driver's License #  & State: ____________     ______   License Plate #: ____________

Auto-Year: ____ Make: _____________ Model: ______________ Color: ___________

In Case Of Emergency, Notify:

Name: ______________________ Relationship: ___________ Phone: #______________

Name: ______________________ Relationship: ___________ Phone: #______________

Employer: ____________________  Address: ________________________ Phone #_______________
Position: _________ Hire Date: _________ End Date: _______ Salary: _________ Supervisor:_________

Prev. Employer: ______________ Address: ____________________________ Phone #_____________
Position: _________ Hire Date: _________ End Date: _______ Salary: _________ Supervisor:_________

Credit Reference:  _____________________________________________________
Additional Credit Reference:  _____________________________________________

Personal Reference: Three family members and three non-family members!

Name: ________________ Relationship: ___________ Phone: #_____________
Name: ________________ Relationship: ___________ Phone: #_____________
Name: ________________ Relationship: ___________ Phone: #_____________
Name: ________________ Relationship: ___________ Phone: #_____________
Name: ________________ Relationship: ___________ Phone: #_____________
Name: ________________ Relationship: ___________ Phone: #_____________

Have you ever: (if yes, when? and explain!)                       

Filed for bankruptcy?_________________________________________________
Been evicted from tenancy?____________________________________________
Willfully or intentionally refused to pay rent when due? ________________________

Checklist:
_____ Pay Stubs (2)                   _____ Utility Bills (2)   
_____ Application Fee ($35)      _____ Rent Receipts/Canceled Checks (3)

I recognize that as a part of your procedure for processing my application, an investigative consumer report may be prepared. Additional information is obtained through personal interviews with my neighbors, friends, and others with whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics, and mode of living. I acknowledge that the $35.00 application fee is mandatory and non-refundable.

The above information to the best of my knowledge is true and correct.

Signature of Applicant: ____________________________  Date: ________________

Co-applicants must file separate applications.