Landlord Association of PA

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Online Renewal Application

Complete the form below.
Questions? Call 888-778-2173

Name:
Address:

City:
State:
Zip Code:
Social Security No:
Phone:
Fax:
Email:
Number Rental Units:	(units not buildings)
Type of Properties:	Residential Commercial Both
Location:	Primary County
Identification Forms:	ONE OF THE FOLLOWING: Copy of Signed Lease Landlord License Copy of a tax bill for rental property PLUS Photo Identification
Contact Person:	(your manager, etc.)
Payment Method:	Check Money Order Credit Card (complete information below)
	Visa MasterCard Am Ex Discover Card Number: Expiration Date: (MM/YYYY) Security Code: Name as it appears on the credit card:
Mail payments to: Landlord Association of Pennsylvania 1414 Millard Street Bethlehem, PA 18018