129 Brown Street, Lewisburg, PA 17837

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.