Voice 510/657/9946 fax 510/657/9949
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APPLICATION: For Credit To Obtain Rental Property.
Name-Last, _______________ First, _______________MI, ____ Spouse, ____________
Birth Date, MM-DD-YY, _____________ Spouse Birth Date, _____________________
Social Security #, _____________________ Spouse SS #, ________________________
Present Address, ______________________ City, ____________________ State,_____
Zip, ___________ How Long, _________ Home Phone, __________________________
Landlord Name, ________________________ How Long, _______________________
Landlord Phone number, ______________ Rent, _________30-Day Notice, Y ___ N___
Prior Address, __________________________ How Long, _______________________
Prior Landlord, __________________________________ Phone, __________________
Employer, _______________________ Salary, $_______________ Monthly/Yearly
Phone, _______________ How Long, ________ Position, ________________________
Employer Address, ________________________________________________________
Prior Employment, _______________________________ Phone, __________________
Spouse Employer, _________________ Spouse Salary, $____________Monthly/Yearly
Phone, _______________ How Long, _________ Position, _______________________
Spouse Employer Address, _________________________________________________
Spouse Prior Employment, _________________________ Phone, __________________
# Children, _______ Ages, _______________ Pets, __________ Type, ______________
Pets Names, _____________ ________________ ____________________________
Nearest relative Name: ____________________________
Address: ____________________________________________ Phone: ____________
Personal Reference:
Address: _____________________________________________ Phone: ___________Have you ever filed a petition of bankruptcy? ___ Have you ever been evicted from any tenancy or had an eviction notice served on you and/or been a part of an unlawful detainer? ___ Are you a smoker of tobacco Products? ___ I agree to pay a non-refundable screening fee of $20.00, CASH per adult.
I declare that the foregoing information is true and correct, and I authorize its verification and the obtaining a credit report. I agree that the Landlord may refuse tenancy due to a misstatement made above. Should I fail to fulfill the terms of the rental agreement the Owners or Agents are authorized to report the resulting credit information to a credit-reporting agency.
Signature, ________________________ Date, ______________________
Signature, ________________________ Date, ______________________