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Rental Application - 1023 Brusselles

IMPORTANT: If you are filling this application on a mobile phone, to view this application properly, please rotate your phone to landscape mode (sideways).

If the applicant or co-signer has any questions while filling this application, please contact Anne Horning at 814-335-6389 (or) ahorning@crownrealtypa.com

APPLICANT HAS NO RELATIONSHIP WITH PA LICENSED BROKER. Broker listed below is an agent of the Landlord, who works exclusively for the Landlord and must act in the Landlord’s best interest.

CONSUMER NOTICE FOR TENANTS - THIS IS NOT A CONTRACT

Anne Horning (Licensee) hereby states that with respect to this property 1023 Brusselles St, Saint Marys, PA 15857, I am acting in the following capacity: An agent of the Owner/Landlord pursuant to a property management or exclusive leasing agreement

I acknowledge that I have received this Notice:

Full Legal Name of the Applicant

Today's Date

Applicant's Signature

Signature

LANDLORD'S RELATIONSHIP WITH PA LICENSED BROKER

Broker (Company): Company License: Company Address: Company Phone:

Crown Realty Services RB067085 23 E 4th St, Emporium, PA 15834 814-486-0313

Broker is Landlord Agent (Broker represents Landlord only)

Licensee Name: State License: Direct Phone: Cell Phone: Email:

Anne Horning RM421475 814-486-0313 814-335-6389 ahorning@crownrealtypa.com

Licensee is Landlord Agent with Designated Agency (only Licensee(s) named above represent Landlord)