Rent
Security
Pet Fee
App. Fee
Your Property Watchdog !
$___________________
$___________________
$___________________
$________App Ran_________
Payment $__________ Date ______
Payment $__________ Date ______
Balance Due $__________________
Address applying for: _____________________________________________________ Apt# _______
Rental amount: _________ To move in: ____/_____/_____ Email Address: ______________________
Applicant's Name: ___________________________ Middle Initial: ______ SS# _____/_____/_____
Phone # (_____) _________________ Alt. Phone # (_____) ________________ DOB ____/____/____
Co-Applicant's Name: ______________________________________ Middle Initial: _______
Co-App. SS# ____/___/____ Co-App. DOB ____/____/____Co-App. Phone # (____) ______________
Driver's License or State issued ID: ___________________________State__________
Driver's License or State issued ID Co-App. _____________________State_________
Current Address: _____________________________ City ______________ St ______ Zip________
Previous Address: _____________________________ City _______________ St ______ Zip _______
Current Landlord Information:
Landlord or Contact Name: ________________________________Phone # (_____) _______________
Landlord Address: ________________________ City: ______________ St: _____ Zip: _____________
Monthly Rental Amount: _______________ Resided on premises from: ___________To: ___________
Employment Information:
Present Employer/Company Name: ______________________________________________________
Address: ________________________________City: _________________ St: _____ Zip: __________
Supervisor's Name: ___________________________________ Phone # (_____) __________________
Position: __________________________ Salary $ ____________ Start Date: _____________________
Co-Applicant:
Employer/Company Name: _____________________________________________________________
Address: _____________________________City: _________________ St: _____ Zip:_____________
Supervisor's Name: ___________________________________ Phone # (____) ___________________
Position: __________________________Salary $_____________ Start Date:_____________________
Non-Financial Occupant:
Name: _________________________ SS# ____/____/_____ Phone # (____) ___________ DOB: ___/___/____
I/We confirm that all the information supplied is true and correct. I/we understand that I/we can be turned down for
the apartment if I/we have falsified any information on this application. I/we hereby authorize the verification of all
above information by AppFolio including my credit, housing court filings, rental, check writing, employment
history including salary, and criminal background.
Applicant's Signature ______________________________________ DATE ________
Co-Applicant's Signature ___________________________________ DATE ________
Non-Financial Occupant’s (Over 18) Signature ______________________________ DATE _________
___________________________________________________________________________
1128 N 5th St., Stroudsburg, PA 18360 570-424-8131/FAX 570-424-8110
Your Property Watchdog !
Emergency Contact: ______________________________________________________________
Relationship: ______________________________ Phone: ________________________
Emergency Contact: ______________________________________________________________
Relationship: ______________________________ Phone: ________________________
List All Occupants Names & Ages: ___________________________________________________
_________________________________________________________________________________
All Vehicles (make, model, plate number): ______________________________________________
__________________________________________________________________________________
Personal References: Please do not include family members
Name: ____________________________________________________________
Relationship: __________________________ Phone: _____________________
Name: ____________________________________________________________
Relationship: __________________________ Phone: _____________________
DO YOU OWN A PET? Y N Type__________ Name ________________ Breed _____________
Type__________ Name ________________ Breed _______________
If Pets are allowed at this rental a onetime pet cleaning fee of ½ months’ rent will be due at Lease
signing
DO YOU OWN A WATERBED? ____Yes ____No DO YOU SMOKE? ____Yes ____No
HAVE YOU EVER BEEN CONVICTED OF A CRIME? ____ Yes ____ No
Please include a $35 application fee (per applicant) with submittal of these forms.
Mail to: D-N-A Property Management Co.
1128 N. 5th St.
Stroudsburg, PA 18360
Consumer Notice to Applicants
D-N-A Property Management Company hereby states that with respect to this property:
____________________________________________________________________________________
I am acting in the capacity as an agent of and for the Owner/Landlord pursuant to a property
management or exclusive leasing agreement.
I acknowledge that I have received this notice:
Date:_______________ _____________________________ _______________________________
Print (consumer)
Print (consumer)
______________________________ _______________________________
Signed (consumer)
Signed (consumer)
I certify that I, ________________________________________, have provided this notice to the above
consumer(s) on _______________, 20___.
PA Real Estate License #_____________________
___________________________________________________________________________
1128 N 5th St., Stroudsburg, PA 18360 570-424-8131/FAX 570-424-8110
Your Property Watchdog !
Receipt For Holding
This agreement between _________________________________ D-N-A Property Management Co. is
for the lease of
_______________________________________________________
The rent is ____________ per month; payable on or before the first of each month.
A Deposit of ____________ From applicant is nonrefundable unless D-N-A Property Management
does not approve the applicant.
Tenant must pay balance of $ __________ for rent and $ __________ for security deposit in cash
or money order by _____________________ and take possession by ________________________.*
* Tenant Understands That They Will Incur Rental Charges Beginning on the Stated Date of Possession. If Tenant Does Not Take Possession
Within Seven (7) Days of the Stated Date, All Deposit Money Will Be Forfeited and the Property Will Be Placed Back on the Market. *
________________________________________
Representative of
D-N-A Property Management Co.
__________________________________
Applicant's Signature
Estimate of Other Fees That May Be Associated With This Rental:
Tenant Registration Fee:
$ _______________
Car Pass Fee:
$ _______________
Amenity Badge Fee: $ _______________
Other Fees:
_____________________
_____________________
_____________________
$ _______________
$ _______________
$ _______________
___________________________________________________________________________
1128 N 5th St., Stroudsburg, PA 18360 570-424-8131/FAX 570-424-8110
Your Property Watchdog !
Applicant's Receipt
This agreement between _________________________________ D-N-A Property Management Co. is
for the lease of
_______________________________________________________
The rent is ____________ per month; payable on or before the first of each month.
A Deposit of ____________ From applicant is nonrefundable unless D-N-A Property Management
does not approve the applicant.
Tenant must pay balance of $ __________ for rent and $ __________ for security deposit in cash
or money order by ______________________ and take possession by ________________________.
* Tenant Understands That They Will Incur Rental Charges Beginning on the Stated Date of Possession. If Tenant Does Not Take Possession
Within Seven (7) Days of the Stated Date, All Deposit Money Will Be Forfeited and the Property Will Be Placed Back on the Market. *
________________________________________
Representative of
D-N-A Property Management Co.
__________________________________
Applicant's Signature
Estimate of Other Fees That May Be Associated With This Rental:
Tenant Registration Fee:
$ _______________
Car Pass Fee:
$ _______________
Amenity Badge Fee: $ _______________
Other Fees:
_____________________
_____________________
_____________________
$ _______________
$ _______________
$ _______________
___________________________________________________________________________
1128 N 5th St., Stroudsburg, PA 18360 570-424-8131/FAX 570-424-8110