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AUTHORIZATION
In connection with my rental application, I authorize (the “Landlord or Property
Management Company”) to obtain a “consumer report” (a background report) about me. The background
check company who will be conducting such checks is Tenant Screening Center, Inc., 6570 Oakmont Drive,
Suite B, Santa Rosa, CA 95409, toll-free phone: 1-800-523-2381, www.tsci.com.
I acknowledge the background report may contain information concerning my character, general reputation,
personal characteristics, mode of living, and credit history/standing. The types of information that may be
obtained include, but are not limited to: social security number verification, criminal records check, verification
of previous and current landlords, verification of employment, and credit reports.
Selection criteria that may result in denial of my rental application includes: criminal history; previous rental
history; credit history; or failure to provide accurate or complete information on the application form.
I agree the Landlord or Property Management Company may rely on this form to obtain background reports
throughout my tenancy without asking me for my authorization again as allowed by law. I also agree that a
copy of this form is valid like the signed original. I certify that all of the personal information I provided is true
and correct.
Signing this acknowledgment indicates that you have had the opportunity to review the landlord's tenant
selection criteria. The tenant selection criteria may include factors such as criminal history, credit
history, current income, and rental history. If you do not meet the selection criteria, or if you provide
inaccurate or incomplete information, your application may be rejected and your application fee will not
be refunded.
Washington State applicants: You also have the right to request from the consumer reporting agency a written
summary of your rights and remedies under the Washington Fair Credit Reporting Act.
_______________________________________
Print Name
_______________________________________ _____/_______/________
Applicant Signature Date (Month/Day/Year)
_______________________________________
Print Name
_______________________________________ _____/_______/________
Applicant Signature Date (Month/Day/Year)
REV09/18
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