Rental Application

Separate application required from each applicant age 18 or older.

This section to be completed by landlord

Address of Property to Be Rented: 3943 Loch Lomond dr. Orcutt CA 93455

Rental Term: [ x ] month to month [ ] lease from _____________ to _____________

Amounts Due Prior to Occupancy

First months rent $1900

Security deposit $1900

Application fee $30/per application

Credit Check (paid separately): $28.50 (paid at applyconnect.com)

TOTAL: $3830

Applicant

Full Nameinclude all names you use(d): __________________________________

Home Phone: ___________ Work Phone: ___________ Cell phone: _____________

Fax (By providing this number, I agree to receive Fax transmissions from the landlord

or landlord's agent): __________________________________

Social Security Number: ___________ Drivers License Number/State: ___________

Other Identifying Information: ___________

Vehicle Make: __________ Model: __________ Color: __________ Year: ________

License Plate Number/State: __________________________________

Additional Occupants

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Full Name Relationship to Applicant

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

Rental History

Current Address: ______________________________

Dates lived at address: ____________ Reason for leaving: __________________

Landlord/manager: ____________ Landlord/manager's phone: ____________

Previous Address: ______________________________

Dates lived at address: ____________ Reason for leaving: __________________

Landlord/manager: ____________ Landlord/manager's phone: ____________

Previous Address: ______________________________

Dates lived at address: ____________ Reason for leaving: __________________

Landlord/manager: ____________ Landlord/manager's phone: ____________

Employment History

Name and Address of Current Employer: ______________________________

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Name of supervisor: ____________ Supervisor's phone: ____________

Dates employed at this job: ____________ Position or title: ___________________

Name and Address of Previous Employer: __________________________________

Phone: ______________

Name of supervisor: ____________ Supervisor's phone: ____________

Dates employed at this job: ____________ Position or title: ___________________

Income

1. Your gross monthly employment income (before deductions): $___________

2. Average monthly amounts of other income (specify sources): $___________

_____________________________________________________________________

_____________________________________________________________________

TOTAL: $___________

Miscellaneous

Describe the number and type of pets you want to have in the rental property:

_____________________________________________________________________

Describe water-filled furniture you want to have in the rental property:

_____________________________________________________________________

Do you smoke? [ ] yes [ ] no

Have you ever:

Filed for bankruptcy? [ ] yes [ ] no

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Been evicted? [ ] yes [ ] no

Been convicted of a crime? [ ] yes [ ] no

Explain any "yes" listed above:

__________________________________________________________________

References and Emergency Contact

Personal reference: ________________ Relationship: ________________

Address: ___________________________________________________________

Phone: ________________

Personal reference: ________________ Relationship: ________________

Address: ___________________________________________________________

Phone: ________________

Contact in Emergency: ________________ Relationship: ________________

Address: ___________________________________________________________

Phone: ________________

I certify that all the information given above is true and correct and understand that my
lease or rental agreement may be terminated if I have made any material false or
incomplete statements in this application. I authorize verification of the information
provided in this application from my credit sources, credit bureaus, current and previous
landlords and employers, and personal references. I understand that if I have initiated a
"security freeze" on my credit information with any of the credit reporting agencies, I will

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Date _____________________________ Applicant ___________________________

Notes (Landlord/Manager):

_____________________________________________________________________

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