24 E. Main St., Bloomsburg, PA 17815

Rental Application

    Separate application required from each applicant age 18 or over.

    Personal Information

    Additional Occupants

    List everyone, including children, who will live with you.

    Occupant 1

    Occupant 2

    Occupant 3

    Occupant 4

    Rental History




    Have you ever:

    References & Emergency Contacts

    Reference 1

    Reference 2

    Reference 3

    Reference 4

    By submitting this application, I certify that all information given above is true and correct and understand that my lease or rental agreement may be terminated if I have made any false or incomplete statement in this application. I authorize verification of the information provided in this application from my credit sources, current and previous landlords and employers, and personal references.