(FIRST, LAST, MI.) NAME

SOCIAL SECURITY

(area code) CELL PHONE / PAGER

DATE OF BIRTH

DRIVERS LICENSE NO.

STATE

(area code) HOME PHONE

(area code) WORK PHONE

PRESENT

ADDRESS	STREET

CITY

STATE

ZIP CODE

APT. #

1	DATE IN

DATE OUT

OWNER / MGR. NAME

(area code) DAY PHONE

(area code) EVENING PHONE

REASON FOR MOVING

YOUR EMAIL ADDRESS

PREVIOUS

ADDRESS	STREET

CITY

STATE

ZIP CODE

APT. #

2	DATE IN

DATE OUT

OWNER / MGR. NAME

(area code) DAY PHONE

(area code) EVENING PHONE

REASON FOR MOVING

NEXT

PREVIOUS	STREET

CITY

STATE

ZIP CODE

APT. #

3	DATE IN

DATE OUT

OWNER / MGR. NAME

(area code) DAY PHONE

(area code) EVENING PHONE

REASON FOR MOVING

LIST ALL PROPOSED OCCUPANTS INCLUDING YOURSELF	NAME	AGE	NAME	AGE
PLEASE CHECK X IF YOU WILL HAVE ANY OF THE FOLLOWING AT THE RESIDENCE FOR WHICH YOU ARE APPLYING:

WATER BEDS ANY PETS TYPE: ANY MUSICAL INSTRUMENTS	DO YOU OR ANY OF YOUR ROOMATES SMOKE?

YES NO

A	PRESENT

OCCUPATION	EMPLOYER

NAME
HOW LONG WITH

THIS EMPLOYER	EMPLOYER

ADDRESS
NAME OF YOUR

SUPERVISOR	EMPLOYER (area code)

PHONE NO.

B	PREVIOUS

OCCUPATION	EMPLOYER

NAME
HOW LONG WITH

THIS EMPLOYER	EMPLOYER

ADDRESS
NAME OF YOUR

SUPERVISOR	EMPLOYER (area code)

PHONE NO.
CURRENT GROSS INCOME

$ PER	PLEASE CHECK “ X “ APPLICABLE PERIOD
WEEK	MONTH	YEAR
NAME OF YOUR BANK

(area code) PHONE NUMBER

CHECKING ACCOUNT NUMBER

SAVINGS ACCOUNT NUMBER

NAME OF CREDITOR	ACCOUNT NUMBER	CREDITOR’S (area code) PHONE NUMBER	MO. PAYMENT	BALANCE	DATE OPENED

IN CASE OF EMERGENCY, NOTIFY:	ADDRESS	(area code) PHONE	CITY	RELATIONSHIP
PERSONAL REFERENCES	ADDRESS	(area code) PHONE	CITY	YEARS KNOWN	OCCUPATION
AUTOMOBILE MAKE:	MODEL:	YEAR:	LICENSE NUMBER:	STATE:
AUTOMOBILE MAKE:	MODEL:	YEAR:	LICENSE NUMBER:	STATE:
MOTORCYLE, BOATS OR OTHER VEHICLES:	TYPE:	MODEL:	YEAR:	LICENSE NUMBER:	STATE:
HAVE YOU EVER BEEN EVICTED OR ASKED TO MOVE? YES NO	CIRCUMSTANCE:
HAVE YOU EVER BEEN CONVICTED OF A FELONY OFFENSE? YES NO	EXPLAIN:
HAVE YOU EVER FILED FOR BANKRUPTCY? YES NO	EXPLAIN:
DO YOU HAVE GOOD CREDIT? YES NO	EXPLAIN:
PLEASE CHECK X HOW YOU FIRST FOUND THIS RENTAL: NEWSPAPER SAW A FLYER SAW A YARD SIGN INTERNET REFERRAL
PLEASE CHECK X WHICH APPLIES TO YOUR SITUATION: I PREFER A GARDENER? I AM WILLING TO HAND WATER A YARD 3 TIMES WEEKLY?

I’M WILLING TO DEVOTE ONE DAY PER WEEK TO MOW, EDGE, RAKE, PRUNE AND WEED AN ENTIRE YARD? I OWN A POWER MOWER AND RAKE?

APPLICANT REPRESENTS THAT ALL THE ABOVE STATEMENTS ARE TRUE AND CORRECT AND HEREBY AUTHORIZES VERIFICATION OF THE ABOVE ITEMS INCLUDING BUT NOT LIMITED TO THE OBTAINING OF A CREDIT REPORT AND AGREES TO FURNISH ADDITIONAL REFRENCES ON REQUEST.

THE UNDERSIGNED MAKES APPLICATION TO RENT HOUSING ACCOMMODATIONS LOCATED AT:

THE RENTAL FOR WHICH IS $	PER MONTH and upon approval of this application agrees to sign a lease agreement and pay all sums due, including required security deposit, (1st month’s Gardener fee if applicable), and all city utilities including water, garbage, sewer and street clippings pick-up. Upon signing of lease, applicant agrees to pay the above fees, exclusive of a fully prepaid security deposit, thereafter, by the first day of every month.

Dated:
APPLICANT SIGNATURE (Print this form, sign and fax to 916-966-4005)

ASSOCIATION CODE FOR EQUAL OPPORTUNITY

Equal opportunity in the rental industry can best be accomplished through leadership, example, education and the cooperation of the owners, managers and the public. In the spirit of this endeavor, this association adheres to the following provisions:

In the rental, lease, sale, purchase or exchange of real property, owners and their managers have the responsibility to offer housing accommodations to all prospects without regard to color, race, religion, sex, marital status, physical handicaps, national origin or any unlawful discrimination, including all other statutes applicable to equal opportunities.

Members shall stand ready to enter in to owner / resident relationships and to show housing accommodations to all equally.

Members, individually and collectively, in performing these functions have no right or responsibility to volunteer information regarding the racial, creed or ethnic composition of any neighborhood or any part thereof unless required by law.

Members shall not print, display or circulate any statement or advertising with respect to the rental or sale of a dwelling that indicates any preference, limitations or discrimination.

As there may be others interested in this property, please print out all pages and fax your completed and signed application to: 916-966-4005 fax. Our main number 916-448-2258 is not a fax line!

Or mail, along with a $30 fee for each adult to:	East Bidwell & Glenn, LLC

5046 Sunrise Blvd., Suite 1

Fair Oaks, CA 95628

Or print out all pages, and submit a set for each adult, along with the appropriate fee, to the rental agent at the time of showing. Please provide (area codes) with all telephone numbers.

If you have any rental or application questions, please call Brenda for info @ 916-448-2258.

PLEASE LIST ALL FINANCIAL OBLIGATIONS BELOW

APPLICATION TO RENT

Each adult applicant must include a $30.00 application fee with their completed application. This can be done at time of showing. Print and or fax directly to 916-966-4005. End of page 2 contains specific submission instructions.

CHK PRODUCTIONS

(1997 All Rights Reserved.

NAME

jperez

2008-04-08