VALLEY OAKS VILLAGEAPPLICATION TO RENT
Resident Guarantor (Credit Report Only)
(All sections must be completed) Separate applications required from each occupant 18 years of age or older.
Resident InformationLast Name First Name Middle Initial / Date of Birth / Age
1st Government Issued ID# / 2ndGovernment issued ID# (w/photo) / State / Home Phone #
( ) / Cell Phone #
( )
1. / Present Address City State Zip Code / Date In / Date Out
Owner/Manager Name Owner/Manager Phone # / Current Rent
$ /mo. / Reason for moving out
2. / Previous Address (if within 5 years) City State Zip Code / Date In / Date Out
Owner/Manager Name Owner/Manager Phone # / Reason for moving out
3. / Next previous Address City State Zip Code / Date In / Date Out
Owner/Manager Name Owner/Manager Phone # / Reason for moving out
List all other proposed occupants in addition to yourself
Last Name First Name / Date of Birth / Age / Government Issued ID#
Last Name First Name / Date of Birth / Age / Government Issued ID#
Employer/Income Information
Employment Information (If Employed)
Current occupation: / Employer name
How long with this employer? / Supervisor’s Phone #
( ) / Employer address
Name of your supervisor / City, State, Zip
Other Income Information
Source: / Amount:
$ per/ (check one) Week Month Year
Source: / Amount:
$ per/ (check one) Week Month Year
Source: / Amount:
$ per/ (check one) Week Month Year
Current gross income
$ per/ (check one) Week Month Year / Are you receiving Section 8 Rental Assistance from the Housing Authority? Yes No
If yes, which Housing Authority?
Banking Information
Bank Name / Branch / Checking Account NumberBank Name / Branch / Savings Account Number
Automobile Information
Automobile Make: / Model / Year / Color: / License Plate Number:Automobile Make: / Model / Year / Color: / License Plate Number:
Pet Information
/Non-Smoking Acknowledgment N/A
Do you have a pet? Yes NoIf yes, please describe:
Note: Assistive animals for the disabled are not considered to be pets, but do require advance written approval of management. / I understand that this is a 100% non-smoking community and agree to comply with this policy. ______(initials)
Emergency Contact Information
In Case of Emergency Contact
/ Address / Phone / RelationshipPlease answer the following questions: / Yes / No
Have you ever been evicted or asked to move?
Have you ever filed for bankruptcy?
Have you ever been convicted of a felony?
Have you ever been convicted of selling, distributing or manufacturing illegal drugs?
If any question is answered “YES”, please explain fully:
Applicant Consent:
Applicant represents that all of the above statements are true and correct and hereby authorizes their verification including, but not limited to, the obtaining of a credit report, and agrees to furnish additional credit references on request. Owner/Agent is authorized to obtain a credit report, now and in the future, as evidenced by signing below. Applicant expressly authorizes Landlord to contact all persons or firms named as references, former landlords and employers to verify the contents of this Application.
In connection with my application for rental and/or employment, I understand that background inquires will be made on myself including consumer, criminal, driving and other reports. Employment records may include information as to my character, work habits, performance and experience along with reasons for termination of past employment from previous employers. I understand that information will be requested from various federal, state and other agencies and entities, public and private, which maintain records concerning my past activities relating to driving, credit, criminal, civil and other experiences as well as claims involving me in insurance company files.
I authorize, without reservation, any party or agency contacted to furnish, completely and without limitation, any and all of the above mentioned information and any other information related thereto. Further, I will release from liabilityand will defend and hold harmless all requesters and suppliers of information in accordance herewith.
The undersigned makes application to rent housing accommodations designated for the amount and location as set forth above and upon approval of this application agrees to sign a rental or lease agreement and to pay all sums due, including the requested deposits before occupancy. Fraudulent information herein will result in automatic denial of application.
Owner/Agent will require a payment of per Applicant, which is to be used to screen Applicant with respect to credit history and other background information.
The amount charged is itemized as follows:
- Actual cost of consumer report, unlawful detainer (eviction) search, and/or other screening reports $20.00
- Cost to obtain, process and verify screening information (may include staff time and other soft costs) $0.00
- Total fee charged (cannot exceed $44.51 per applicant, which may be adjusted annually with the CPI as of 2013) $20.00
Apt. No. Located at
The rent for which is $ per month. Upon approval of this application, and execution of a rental/lease agreement, the applicant shall pay all sums due, including required security deposit of $, before occupancy.
Applicant’s Signature / Applicants Name Printed / Date
***PLEASE REFER TO THE RENTAL STANDARDS FOR ADDITIONAL INFORMATION***
WSH: Application to Rent (Market Rate)_rev. 082813 1