Online Application


MAXON TOWERS 412-521-7900
Prudential Realty Company
3700 SOUTH WATER STREET-SUITE 100
Pittsburgh, PA. 15203 (412) 261-6500
Fax Number (412) 261-0740

If you prefer to fill out a printable version of the application and fax or hand deliver it click here.

Rental Application
Name of Applicant:
Social Security Number: DOB:
Name of Co-Applicant:
Social Security Number: DOB:

Dependent(s)Names and Ages:
1
2
3
4


APPLICANT
Current Address
Street: City:
State: Zip Code: Phone:

Present Landlord:
Phone:
Current Rent Amount: $ How long at above:
Previous Landlord: Zip Code:
Phone:
Employer/Income Source:
Phone:
Address:
Hourly Wage: $ Annual Income: $

CO-APPLICANT
Current Address
Street: City:
State: Zip Code: Phone:

Present Landlord:
Phone:
Current Rent Amount: $ How long at above:
Previous Landlord: Zip Code:
Phone:

Employer/Income Source:
Phone:
Address:
Hourly Wage: $ Annual Income: $


AUTOMOBILE INFORMATION
Applicant's Drivers License: Co-Applicant's Drivers License:
Car License Plate: Car License Plate:
Make/Year: Make/Year:

It is understood and agreed that not more than the number of persons shown above will occupy said dwelling. In the event the party or parties herein do not consummate a written lease covering dwelling, this application shall constitute the agreement of the applicant(s) as though it were a fully executed lease, subject, however to the Landlord's investigation and approval of the applicant.

I understand that I acquire no rights in a dwelling until I sign a lease in the form submitted to me and make a deposit equal to one month's rent on the apartment I have selected, which deposit is to be held as long as I occupy the apartment. In case of cancellation, the Security Deposit is forfeited. In consideration of the Landlord's holding this dwelling for me, I hereby waive all rights to the return of this deposit and forfeit as liquidated damages in the event that I do not choose to enter into the lease applied herein.

I recognize that as a part of your procedure and processing my application an investigative consumer report may be prepared, whereby information is obtained through personal interviews, with the credit bureau, landlords, employers, and others whom I may be acquainted. This inquiry includes information as to my character, general reputation, personal characteristics, and mode of living.


No pets will be allowed on the premises.

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

Applicant(s) Signature Apartment Requested: # Start-up Date: Unit Type:
Signature of Applicant: Signature of Co-Applicant:

Filling in your name is considered the same as a signature.

I agree with the terms of this agreement: Yes No

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