You can always press Enter⏎ to continue
Homeshare Reservation Agreement
This agreement will require you to upload a Government-issued photo ID and proof of income - please have those items ready.
21
Questions
START
Accessibility
Enabled Form
1
Full Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Submit
Press
Enter
2
E-mail
*
This field is required.
example@example.com
Previous
Next
Submit
Submit
Press
Enter
3
Phone Number
*
This field is required.
Previous
Next
Submit
Submit
Press
Enter
4
Date of Birth
*
This field is required.
All Occupants Must Be Over The Age of 18
-
Date
Month
Day
Year
Previous
Next
Submit
Submit
Press
Enter
5
Social Security Number
*
This field is required.
Previous
Next
Submit
Submit
Press
Enter
6
Photo ID
Please Upload a Government-Issued Photo ID or Driver's License
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
Cancel
of
Previous
Next
Submit
Submit
Press
Enter
7
Vehicle Information
All vehicles parked at Homeshare properties must be registered with our office and a parking pass sticker must be visible at all times to avoid towing.
Vehicle Make/Model
Vehicle Color
Vehicle Year
License Plate #
Previous
Next
Submit
Submit
Press
Enter
8
Have you ever been a Homeshare customer before?
YES
NO
Previous
Next
Submit
Submit
Press
Enter
9
Have you ever been convicted of a felony?
Please Select
Yes
No
Please Select
Please Select
Yes
No
If Yes, What was the offense?
Previous
Next
Submit
Submit
Press
Enter
10
Are you on Parole?
Please Select
Yes
No
Please Select
Please Select
Yes
No
Are you on Parole?
If Yes, Name of Parole Officer
If Yes, Phone Number of Parole Officer
Previous
Next
Submit
Submit
Press
Enter
11
Employer
*
This field is required.
Previous
Next
Submit
Submit
Press
Enter
12
Employer Phone Number
Previous
Next
Submit
Submit
Press
Enter
13
Current Salary
*
This field is required.
Previous
Next
Submit
Submit
Press
Enter
14
Proof of Income
Please Upload Your Most Recent Pay Stubs or Bank Statement
Drag and drop files here
Select files to upload
Max. file size
: 10.0MB
Upload a File
Cancel
of
Previous
Next
Submit
Submit
Press
Enter
15
Full Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Submit
Press
Enter
16
Relationship
*
This field is required.
Previous
Next
Submit
Submit
Press
Enter
17
Phone Number
*
This field is required.
Previous
Next
Submit
Submit
Press
Enter
18
E-mail
example@example.com
Previous
Next
Submit
Submit
Press
Enter
19
Terms and Conditions
*
This field is required.
I do hereby understand and agree that this building is a Rooming House, and this is
NOT a tenancy agreement
. I do not have exclusive possession. It is further agreed that in the event I am ejected, for any reason whatsoever, I forfeit and waive all rights to monetary and non-monetary claims as a result of my occupancy, dealings with, and/or ejection against Homeshare Harrisburg, LLC, it's affiliates, agents or subsidiaries in compensation for my bad debt to be waived. Homeshare Harrisburg, LLC, reserves the right to enter your room/suite at any time for any reason. This is a week-to-week occupancy only. Homeshare Harrisburg, LLC reserves the right to deny/rescind occupancy due to the specific nature of any past criminal offense including but not limited to: drug manufacture/intent to deliver, and any offenses causing harm to another person or property. By filling out this form, I hereby certify that all information above is true and accurate, and I authorize you to perform criminal background and credit checks on me as is deemed appropriate.
Payment is due every Friday by 6:00 PM via CASH, MONEY ORDER, or ELECTRONIC CASH PAYMENT. A daily late fee of $15 will be applied for each day payment is not received.
I understand my occupancy fee is subject to periodic increases upon one-week written notice. I agree to vacate the premises
immediately
if I am in violation of any Major/House Rule (as posted on premises) or if my occupancy fee is not paid. I understand and agree that no warning is required for ejection. This agreement supersedes and replaces any and all previous agreements, written or oral. If any part of this agreement is deemed to be invalid, the remainder shall remain in full force and effect. This agreement shall be construed as if mutually written by both management and occupant. Homeshare Harrisburg, LLC may change terms and conditions at any time without notice.
To receive a full security deposit refund occupant must:
-Give one week written notice on a Friday -Return key to the office -Leave the unit clean
All monies given to hold a unit as well as the application fee are NON-REFUNDABLE after assigned a unit
I will be held financially responsible for any and all damages inflicted by myself/guests. Unpaid damages will be submitted to collections.
By completing this reservation, I authorize Homeshare Harrisburg, LLC to complete a background and credit check.
Previous
Next
Submit
Submit
Press
Enter
20
Signature
*
This field is required.
General Release: To the fullest extent permitted by law, I, for myself, and anyone affiliated with me, do hereby waive any rights I may have to sue the owner of this property, or any of its agents or affiliates with respect to personal injury or property damage suffered by myself and / or anyone affiliated with me as a result of any and all of our activities on the property and hereby release the owner and its agents and affiliates from any liability for such injury or damage. This Release shall be binding upon my heirs, personal representatives and assigns, and me and shall be governed by and construed under the laws of the Commonwealth of Pennsylvania, which shall be the venue for any legal action. This Release constitutes the entire agreement among the parties hereto with respect to the subject matter of this Release and supersedes any and all previous agreements among the parties, whether written or oral, with respect to such subject matter.
Previous
Next
Submit
Submit
Press
Enter
21
Date
-
Date
Month
Day
Year
Previous
Next
Submit
Submit
Press
Enter
Should be Empty:
Question Label
1
of
21
See All
Go Back
Submit
Submit
.6a3d6ba9f24ae6.10082137.png)