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Rental Application

Rental Application General

I. APPLICATION TO RENT

This section to be completed by applicant, a separate application to rent is required for each occupant 18 years of age or over, or an emanicipated minor.

Applicant is completing Application as a (check one)  tenant, tenant with co-tenant(s) or guarantor/co-signor.

Total number of applicants .

PREMISES INFORMATION

Application to rent property at ("Premises")

Rent: $ per: Month Proposed move-in date Date of Birth:

PERSONAL INFORMATION

FULL NAME OF APPLICANT

Social security No. Driver's License No. State Expires

Phone number: Home Work Other

Email

Name(s) of all other proposed occupant(s) and relationship to applicant

Pet(s) or service animals (number and type)

Auto: Make Model Year License No. State Color

Other vehicle(s):

In case of emergency, person to notify Relationship

Address Phone

Does applicant or any proposed occupant plan to use liquid-filled furniture?  No Yes Type

Has Applicant been an party to an unlawful detainer action or filed bankruptcy within the last seven years  No Yes

If yes, explain

Has Applicant or any proposed occupant ever been convicted of or pleaded no contest to a felony  No Yes

If yes, explain

Has Applicant or any proposed occupant ever been asked to move out of a residence  No Yes

If yes, explain

RESIDENCE HISTORY

Current address

City/State/Zip

From to

Name of Landlord

Do you own this property?  No Yes

Reason for leaving current address

Current address

City/State/Zip

From to

Name of Landlord

Do you own this property?  No Yes

Reason for leaving current address

EMPLOYMENT AND INCOME HISTORY

Current employer Supervisor From To

Employer's Address Supervisor's Phone

Position or title Phone Number to verify Employment [tel em-verify-ph]

Employment gross Income $ per other $ Source

Previous Employer Supervisor From To

Employer address Supervisor's Phone

Position or Title Employment Gross Income $ per

Property Address: Date:

CREDIT INFORMATION

Name of Creditor

Account number

Monthly Payment

Balance due

Name of Bank/Branch

Account number

Type of Account

Account Balance

PERSONAL PREFERENCES

Name Address

Phone Length of acquaintance Occupation

Name Address

Phone Length of acquaintance Occupation

NEAREST RELATIVE(S)

Name Address

Phone Relationship

Name Address

Phone Relationship

Applicant understands and agrees;(I) this is an application to rent only and does not guarantee that applicant will be offered the Premises; and (ii) Landlord or Manager or Agent may accept more than one application for the Premises and, using their sole discretion, will select the best qualified applicant.

Applicant represents the above information to be true and complete, and hereby authorizes Landlord or Manager or Agent to: (i) verify the information provided; and (ii) obtain credit report on applicant.

If application is not fully completed, or received without the screening fee: (i) the application will not be processed, and (ii) the application and any screening fee will be returned.

Applicant Date Time

Return your completed application and any applicable fee not already paid to: Realty World Regency

Address 2216 Railroad Avenue City Hercules State CA Zip 94547

SCREENING FEE

THIS SECTION TO BE COMPLETED BY LANDLORD, MANAGER OR AGENT.

Applicant has paid a nonrefundable screening fee of $ 37.00, applied as follows: (The screening fee may not exceed $30.00 adjusted annually from 1-1-98 commensurate with the increase in the Consumer Price Index.) A CPI inflation calculator is available on the Bureau of Labor Statistics websites, www.bls.gov. The California Department of Consumer Affairs calculates the applicable screening fee amount to be $ 37.57 as of 2006.

$37.00 for credit reports prepared by Trans Union/Equifax;

$ for (other out-of-pocket expenses); and

$ for processing.

The undersigned has read the foregoing and acknowledges receipt of a copy.

Applicant SignatureDate

The undersigned has received the screening fee indicated above.

Landlord or Manager or Agent Signature Viktor Manrique DRE Lic.# r01224855Date

THIS FORM HAS BEEN APPROVED BY THE CALIFORNIA ASSOCIATION OF REALTORS ® (C.A.R). NO REPRESENTATION IS MADE AS TO THE LEGAL VALIDITY OR ADEQUACY OF ANY PROVISION IN ANY SPECIFIC TRANSACTION. A REAL ESTATE BROKER IS THE PERSON QUALIFIED TO ADVISE ON REAL ESTATE TRANSACTIONS. IF YOU DESIRE LEGAL OR TAX DEVICE, CONSULT AN APPROPRIATE PROFESSIONAL.

This form is available for use by the entire real estate industry. It is not intended to identify the user as a REALTOR ® REALTOR ® is a registered collective membership mark which may be used only by members if the NATIONAL ASSOCIATION OF REALTORS® who subscribe to its Code of Ethics.

Published and Distributed by:

REAL ESTATE of the California Association of REALTORS ®

525 South Virgil Avenue, Los Angeles, California 90020

LRA REVISED 11/09 (PAGE 2 of 2)

Reviewed by Date

APPLICATION TO RENT/SCREENING FEE (LRA PAGE 2 of 2)