Rental Application
Applicant
Full Name—include all names you use(d): __________________________________
Home Phone: ___________ Work Phone: ___________ Cell phone: _____________
Email: _____________	Social Security Number: ___________ 
Driver’s License Number/State: ___________
Other Identifying Information: ___________
Vehicle Make: __________ Model: __________ Color: __________ Year: ________
License Plate Number/State: __________________________________
Additional Occupants
List everyone, including minor children, who will live with you:
Full Name 	Relationship to Applicant
______________________________	______________________________
______________________________	______________________________

Rental History
Current Address: 	______________________________
Dates Lived at Address: ____________	Reason for Leaving: __________________
Landlord/Manager: ____________	Landlord/Manager's Phone: ____________
Previous Address: ______________________________
Dates Lived at Address: ____________	Reason for Leaving: __________________
Landlord/Manager: ____________	Landlord/Manager's Phone: ____________
Previous Address: ______________________________
Dates Lived at Address: ____________	Reason for Leaving: __________________
Landlord/Manager: ____________	Landlord/Manager's Phone: ____________

Employment History
Name and Address of Current Employer: ______________________________
Phone: ______________
Name of Supervisor: ____________	Supervisor's Phone: ____________
Dates Employed at This Job: ____________	Position or Title: ___________________
Name and Address of Previous Employer: __________________________________
Phone: ______________
Name of Supervisor: ____________	Supervisor's Phone: ____________
Dates Employed at This Job: ____________	Position or Title: ___________________

Income
1. Your gross monthly employment income (before deductions):	$___________
2. Average monthly amounts of other income (specify sources):	$___________
_____________________________________________________________________
_____________________________________________________________________
	TOTAL:	$___________

Credit and Financial Information
Bank/Financial Accounts	Account Number	Bank/Institution	Branch	
Savings Account:	________________	________________	________________	
Checking Account:	________________	________________	________________	
Money Market or Similar Account:	
________________	
________________	
________________	

Credit Accounts & Loans	Type of Account (Auto loan, Visa, etc.)	Account Number	Name of Creditor	Amount Owed	Monthly Payment	
Major Credit Card	___________	_______	__________	______	______	
Major Credit Card	___________	_______	__________	______	______	
Loan 
(mortgage, car, student loan, etc.)	___________	_______	__________	______	______	
Other Major Obligation	___________	_______	__________	______	______	

Miscellaneous
Describe the number and type of pets you want to have in the rental property:
_____________________________________________________________________
Describe water-filled furniture you want to have in the rental property:
_____________________________________________________________________
Do you smoke? [  ] yes [  ] no
Have you ever: 
Filed for bankruptcy? [   ] yes    [   ] no 
Been sued? [   ] yes    [   ] no
Been evicted? [   ] yes    [   ] no
Been convicted of a crime? [   ] yes    [   ] no
Explain any "yes" listed above:
__________________________________________________________________

References and Emergency Contact
Personal Reference: ________________ Relationship: ________________
Address:	___________________________________________________________
Phone: ________________
Personal Reference: ________________ Relationship: ________________
Address:	___________________________________________________________
Phone: ________________
Contact in Emergency: ________________	 Relationship: ________________
Address:	___________________________________________________________
Phone: ________________

I certify that all the information given above is true and correct and understand that my lease or rental agreement may be terminated if I have made any material false or incomplete statements in this application. I authorize verification of the information provided in this application from my credit sources, credit bureaus, current and previous landlords and employers, and personal references. I understand that if I have initiated a "security freeze" on my credit information with any of the credit reporting agencies, I will promptly lift the freeze for a reasonable time so that my credit report may be accessed by the Landlord/Manager; and I understand that if I fail to do so, the Landlord/Manager may consider this an incomplete application. (CC § 1785.11.2.) This permission will survive the expiration of my tenancy.

Date _____________________________	Applicant ___________________________