i~.
CALI
FORN
I A
.~
ASSOC
I
AT
I
ON
.,
OF
REALTORS
®
APPLICATION TO RENT/SCREENING
FEE
(CAR.
Form
LRA,
Revi
sed
'1
113)
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 EMAN
CI
PATED MINOR.
1.
Applicant
is
completIng
Application
a8 a (check one)D tenant, D tenant
with
co-tenant(s) orO guarantor/co-signor.
Total number
of
applicants ".
__________________________
_
_____
_
2.
PREMISES INFORMATION
Application to rent property at
Rent: $
3.
PERSONAL INFORMATION
per
., , ("Premises")
Proposed
move-in
date
A. FULL
NAME
OF
APPLICANT
____
-,:,-
__
---;..,.,...,...,_---,,,-
_.,-:--..,,.-..,...,.-.,,-..,.-_
,.,,.,=~___,
B.
Date
of Birth (For purpose
of
obtaining credit reports. Age discrimination
is
prohibited
by
law.)
C.
Social Security
No
. Driver's license
No
.
____
_____________
_ _
Siale
__
Expires
O. Phone Number: Home
E.
Email
Work
Other
F
o.
Name(s)
of
all
other proposed occupant(s) and relalionship
10
applicanl
10
5.
EMPLOYMENT
AND
INCOME HISTORY
C
urrent
employer :-:;==
__________
_
Current employer address
From
To
supervisor~~;;;;~;:::=====~~===
Supervisor phone
Employment
gross income $ per
Other
income
i
nfo
___
____
__
____
_
The
copyright laws
or
the
United
States
(T
We
t7
U.S. Code)
rorbld
the
unautOOrtzed
reproduction
01
this form.
or
any portion
thereof
. by photocopy
machine
or
any
other
means
. Including lacsimile
or
computerized
formats
.
Cop)'rightC
1~1-2013
.
CALIFORNIA ASSOCIATION
OF
REALTORS®,
INC
.
ALL
RIGHTS
RESER
V
ED
.
LRA
RE
VISED
11
113
(PAGE 1 OF 2)
Year
license
No.
State
Color
Previous address
_____________
_
Ci~/S~la~le~Q~iP~~~~~~~~~~~~~~~~
From
to
Name
of
Landlord/Manager
Landlord/Manager's phone
Did
you
own
this property? 0
No
0
Yes
Reason
for
leaving
this
address
Previous
employer,-
____________
_
Prevo
~jmjP;IO~Y;erj.~djd~rejSjs~~~~~~~~~~~~
Fr
om
To
Supervisor
Supervisor
phone
Employment
gross income $ per
Other income
info
Applicant. Initials (
___
I t
__
_
D.~
--
-
APPLICATION
TO
RENT/SCREENING FEE (LRA PAGE 1
OF
2)
CENTURY 21 Mammoth Realty - (760) 914-2121
PropertyAddress:
••
~
.
____________
_________
__________
Date: _
______
_
6 CREDIT INFORMATION
Name
of
creditor
Account number
Monthly payment Balance due
Name
of banklbranch
Accounl number Type
of
account
Account balance
7. PERSONAL REFERENCES
Name
Phone
Name
Phone
Address,
-=====:::<lC<:uj)ati.;;;-================
length of acquaintance _ Occupation
Address,
-=====:::<lC<:uj)ati.;n================
length
of
acquaintance _ Occupation
8.
NEAREST RELATlVE(S)
Name
_______________
____
________
JAddressc-~-------------------------------------------
Phone
Relationship
_______________________
_
Name
Address ;:;;;sh;P:
=======================-_
Phone Relationship
Applicant understands
and
agrees that:
(i)
this is
an
application
to
rent only
and
does not guarantee that applicant will
be
offered the
Premises; (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, and (Iii) Applicant
will
provide a copy
of
applicant's driver's license upon request.
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 a credit report
on
applicant
and
other reports, warnings and verifications
on
and about
applicant,
which
may
include, but
not
be
limited to, criminal background checks, reports
on
unlawful delainers,
bad
checks, fraud
warnings, employmenl
and
tenant history. Applicant further authorizes Landlord or Manager or Agent
10
disclose information
to
prior or
subsequent
owners
andlor agents.
If appiJcation is not fully completed,
or
re
ceived without the screening fee:
(i)
the application will not
be
processed, and (ii) the
appli
ca
tion and any screening fee will
be
returned.
Applicant Dale Time
_____________
_
Return your completed
application and any applicable fee nol already paid
to
:
-=====
===
~:aiE
>::
=
::::
liP
-======
Address City
________
__
_________
Stale Zip
II.
SCREENING
FEE
THIS SECTION
TO
BE COMPLETED BY LANDLORD, MANAGER
OR
AGENT.
Applicant has
paid
a nonrefundable screening fee of $ , applied
as
follows: (The screening
fee
may
not
exceed
$30.00, adjusted annually
from
1-1-98 commensurate with
the
inc
rea
se
in
the Consumer Price Index. A
CPI
inflation
calculator
is
available
on
the Bureau of Labor Statistics website , www.bls.gov.
The
Ca
lifornia Department of Consumer Affairs
calculates the applicable screening fee amount
to
be
$42
.06
as
of
2009
.)
$ for credit reports prepared
by
_________________
--,
==
===:;;::;-:::===-=
$ for (other out-of-pocket expenses); and
$ for processing.
The
undersigned has read Ihe foregoing
and
acknowledges receipt of a copy.
Appilcant
Sign
ature
Dale
The
undersigned has received the screening fee indicated above.
~~~~
__
~~~~
___________
--,CaIBRE Uc.
#,
_
_____
~
-----
Landlord
or
Manager
or
Agent Signature
Date
The
copyright
laws
of
the
Un
i
ted
States
(Title
17
U.S.
COde)
forbid
the
unauthorized
reproduction
of
this
form,
or
any
portion thereol.
by
photoc::opy machille
or
any
other
means
. i
ncfuding
facs
lmne
or
computerized
formats
.
Copyright
C
1998-2013,
CALIFORNIA
ASSOCIATION
OF
REAL
TORS®,
INC
.
ALL
RIGHTS
RESERVED
.
THIS
FORM
HAS
BEEN
APPROVED
BY
THE
CALIFORNIA
ASSOCIATION
OF
REALTORS®
(CAR
.
).
NO
REPRESENTATION
IS
MADE
AS
TO
THE
LEGAL
VALIDITY
OR
AOEQUACY
OF
ANY
PROVISION
IN
ANY
SPEC
I
FIC
TRANSACTION
. A
REAL
ESTATE
BROKER
IS
THE
PERSON
aUALIFIED
TO
AOVISE
ON
REAL
ESTATE
TRANSACTIONS
.
IF
YOU
DESIRE
LEGAL
OR
TAX
AOVICE
,
CONSULT
AN
APPROPRIATE
PROFESSIONAL.
Th
l.
form
It
ava
ilable
lor
use
by
the
entire
real
estate
Industry
.
II
is
not
Intentled
10
id8f1tf)!
the
user
as
a
REALTORCI
.
REALTORCI
Is
a
registered
collectiVe
membeBhlp
mar\(
WhIch
may
be
used
only
by
memboB
of
the
NATIONAL
ASSOCIATION
OF
REAL
TORS«!
who
SlIbsaibe
10
Its
Code
of
Ethics.
REAL
ESTATE
BUSINESS
SERVICES
,
INC
.
[]
Published and
OIsb1butad
by.
a
.sub$id
iary
of
the c.lifomllJ AssocflJfiM
of
REAL
TORStIP
••
525
South
VIrgil
Avenue.
Los
Angeles.
California
&0020
LRA REVISED 11/13 (PAGE 2 OF
2)
1
ReVIewed
by
APPLICATION TO RENT/SCREENING FEE (LRA PAGE 2 OF
2)
Date
click to sign
signature
click to edit
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