OTHER SOURCE OF INCOME: ______________________________________________ Amount $_________________
PREVIOUS EMPLOYER_______________________________________ Address_____________________ Zip________
How Long? ______________ Job Title________________________________________ Phone #______________________
MONTHLY PAYMENTS
Name and address of creditor Purpose Monthly Payment
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
PERSONAL REFERENCES
Name Address City Phone #
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
______________________________________________________________________________________
NEAREST RELATIVE________________________________Address___________________________________________
City____________________________________________________ Zip_____________ Phone #_______________________
BANK REFERENCE_____________________________ Branch_______________ City____________________________
Checking #________________________________________ Savings #___________________________________________
CAR: Make__________________ Model_________________ Year________________ License #_____________________
HAVE YOU EVER RENTED FROM CALIFORNIA-WEST, INC. BEFORE? Yes_____ No______
If yes, What address? _____________________________________ City ________________________ Zip_____________
HAVE YOU EVER BEEN EVICTED? _____ Why? ___________________________________________
HAVE YOU EVER BEEN CONVICTED OF A FELONY? ________________________________
DO YOU HAVE A PET? _____________________________________
A. If yes, what type of pet? ____________________________19B. How many?_________________
20. DO YOU HAVE A SERVICE ANIMAL? ________________________________________________
20 A. If yes, is the animal required because of a disability?_________________________
20 B. If yes, what work or task is the animal trained to perform?_____________________
APPLICANT DECLARES THAT THE ABOVE IS ACCURATE, COMPLETE AND UNDERSTANDS
THAT ANY MISREPRESENTATION WILL DISQUALIFY THE APPLICANT.
I give California-West, Inc. permission to process this Rental Application at a cost of $20.00, including but
not limited to tenant reference, employment reference, and credit check.
_________________________________ _________________
Signature Date
Rev.Jan/2019
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