Gray and Company Real Estate

 

     Please fill this out in its entirety and email it back to us. IMPORTANT! When filling in information, use your tab key or cursor to advance to the next field. If you hit "enter" it will prematurely submit the form before it's completed.

      If all applicants have submitted the application and filled it out completely, we should be able to qualify your application within 24-48 hours if all applicants have submitted the application. Items left blank will delay or disqualify your application.

CONSUMER NOTICE

THIS IS NOT A CONTRACT

(licensee) Gray and Company Real Estate hereby states that with respect to this property, as described below_________________________, I am acting in the following capacity: (check one)

ð               (i)   owner/landlord of the property

ð               (ii)  a direct employee of the owner/landlord; or

ð               (iii) an agent of the owner/landlord pursuant to a property management or exclusive leasing agreement.

          I acknowledge that I have received this notice:

          (consumer signature)__________________________________(date)_____________________

           I certify that I have provided this notice:          (licensee)___________________________________________(date)____________________

 

Please type the property's address that you are interested in:


Please provide the following contact information for the first applicant:

Name
Street Address
Address (cont.)
City
State
Zip Code
Telephone
E-mail
Social Security #
Driver's License #

Please provide the second applicant's name 

Name
Work Phone
Home Phone
E-mail
Social Security #
Driver License #

Number of people that will be living in the property:

Names of people living in the property:

Dates of birth in order of names listed:

Please provide your most current landlord's or mortgage holder's name 

Name
 Telephone
Rent or Mortgage Payment
How long at that address?

Please provide the previous landlord' name if within five years:

Name
Telephone
Rent payment
How long at that address?

First applicant's employer:

Name
Telephone number
Position
Monthly Income
How many years at this job

Second applicant's employer: 

Name
Telephone number
Position
Monthly Income
How many years at this job

Monthly income from other sources (list source and amount):

How many pets do you have?     What is the type of pet? (dogs, cats, bird, etc.)

How many household members smoke?          

Please provide the name of a two persons to contact in case of an emergency:

1st Person Name
Street Address
Address (cont.)
City
State
Zip Code
Home Phone
2nd Person Name
Street Address
Address (cont.)
City
State
Zip Code
Home Phone

Please list references to assist us in checking your credit history. (Banks, loans, credit cards, local businesses, etc.)


List the bank's name if you hold a checking account.


List the bank's name if you hold a savings account.


Have you ever been convicted of a crime other than a traffic violation? yes  no.

If yes, please explain below:

I hereby authorize those references listed to disclose any and all credit information to Gray and Company Real Estate.check here and type your name below.

    

first applicant's name                      second applicant's name

Hit Counter last updated 11/19/07  Fair Housing and Equal Opportunity

Gray and Company Real Estate is an equal opportunity housing agent
Copyright © 1999 [Gray and Company Real Estate]. All rights reserved.
Revised: March 12, 2008
 

 

    The Pennsylvania Real Estate Commission, Section 608 of the Act, requires that licensees provide consumers with the Consumer Notice at the initial interview.

      Before we can enter into a substantive discussion about your real estate needs you will need to sign a consumer notice which explains your rights as a consumer.  You can obtain the consumer notice at the Pennsylvania Real Estate Commission's web site:  http://www.dos.state.pa.us/bpoa/recommconsnotice.htm or click here to download the Consumer Notice.

     Gray and Company Real Estate, RB-041217-A, 203 Main Street, Brookville, PA  15825 USA, a licensed Pennsylvania broker.  You may call toll free 1-877-562-1020 or call locally at (814) 849-4199.  You can send email to: webmaster@grayandcompany.net with questions or comments about products, services or this web site.  Fair Housing and Equal Opportunity