BANKING INFORMATION
Name of Bank/S&L/Credit Union: __________________________________ Branch or Address:
Checking #: ________________ Approx. Bal. _____________ Savings #: _____________ Approx. Bal.
Name of Bank/S&L/Credit Union: __________________________________ Branch or Address:
Checking #: ________________ Approx. Bal. _____________ Savings #: _____________ Approx. Bal.
CREDIT REFERENCES (Credit Cards/Car Payments/Other Loans)
Company Name: _________________________________ Address/City:
Account #: ____________________________ Present Balance: ______________ Monthly Payment:
Company Name: _________________________________ Address/City:
Account #: ____________________________ Present Balance: ______________ Monthly Payment:
Company Name: _________________________________ Address/City:
Account #: ____________________________ Present Balance: ______________ Monthly Payment:
PERSONAL REFERENCES
Name Address & City Phone
Time
Known
Relationship
( )
( )
( )
EMERGENCY CONTACT
Name: __________________________________ Address:
Relationship: ________________________Email:_______________________ Phone: (_______)
VEHICLES
Year: ______ Make: _____________ Model: ______________ Color: ________ License#: __________ State:
Year: ______ Make: _____________ Model: ______________ Color: ________ License#: __________ State:
Applicant represents that all of the above statements are true and correct and hereby authorizes their verification including,
but not limited to, the obtaining of a credit report, and agrees to furnish additional credit references on request. Owner/Agent
is authorized to obtain a credit report now and in the future. Applicant expressly authorizes Owner/Agent to contact all
persons or firms named above to verify the contents of this Application.
In connection with my application for rental and/or employment, I understand that background inquiries will be made on
myself including consumer, criminal, driving and other reports. Employment reports may include information as to my
character, work habits, performance and experience along with reasons for termination of past employment from previous
employers. I understand that information will be requested from various federal, state and other agencies and entities, public
and private, which maintain records concerning my past activities relating to driving, credit, criminal, civil and other
experiences as well as claims involving me in insurance company files.
I authorize, without reservation, any party or agency contacted to furnish, completely and without limitation, any and all of the
above mentioned information and any other information related thereto. Further, I will release from liability and will defend
and hold harmless all requesters and suppliers of information in accordance herewith.
I declare that all of my statements on this Application to Rent are true and complete. If I fail to answer any question
or give false information, I understand that my application may be rejected. I understand that the Owner/Agent may at
any time furnish information to consumer reporting agencies and other rental housing owners regarding your performance of
your legal obligations, including both favorable and unfavorable information about applicant’s compliance with contractual
obligations.
Date: _______________________ _____________________________________________________
Applicant
UNAUTHORIZED USE PROHIBITED
For Members Only
Apartment Association,
California Southern Cities
Approved Form # F01 – 9/16