Residential Rental Application

(Owner or Agent) □ Prospective Tenant

■
3050 Citrus Circle #118 Walnut Creek, CA 94598
925- 726-3443 DRE# 01467064 □ Guarantor

ach adult or emancipated minor applying for tenancy or other occupancy status must complete
a separate application. Proposed guarantor shall also complete an application.

Property Address Rental Amount/Per Month Security Deposit Estimated Move-In Date

$ $

Personal Information

Full Name of Applicant: First Middle Last Birth Date Social Security # Drivers License/Photo ID # State

Other Names You’ve Used in The Past Email Home Phone Cell Phone & Work Phone

List Names of All Other Applicants/Proposed Occupants and Age of Each Birth Date Relationship

Animals: Number and type

Will any applicant or proposed applicant use liquid-filled furniture? Yes No Type of Liquid Filled Furniture:
Emergency Contact - Name Emergency Contact – Phone # and Address Relationship

Rental History Current Residence Previous Residence Prior Residence

Street Address

City

State & Zip

Last Rent Amount Paid

Date Last Rent Paid

Manager/Property Owner Name

Manager/ Property Owner Phone

Dates of Residency From To From To From To

Do any prospective occupants smoke tobacco or any other product?

Why is applicant seeking to move from current address?

Has any owner/agent listed above complained about any prospective occupant’s behavior or issued any notice to terminate or
notice due to breach of contract? If yes, please explain:

Do You Own Real Property: Yes No If Yes, Address:

Form provided by the East Bay Rental Housing Association® | www.ebrha.com

Residential Rental Application (Rev. 07/19)
© 2019 All Rights Reserved | Page 1 of 3
 Residential Rental Application
Employment & Income Current Employment Previous Employment Prior Employment

Employed By

Address

Employer’s Phone ( ) ( ) ( )

Occupation

Name of Supervisor

Supervisor’s Phone

Gross Income $ Per week/month $ Per week/month $ Per week/month

Dates of Employment From to From to From to

Other Lawful Income Source: Amount: $ Per

Credit Bank/Institution Name/Account # (Use Add’l Sheets of Paper if Needed) Balance On Deposit or Owed

Savings Account

Checking Account

Mo. Payment Amt.

Credit Cards
Mo. Payment Amt.

Auto Loan Mo. Payment Amt.

Other Loans Mo. Payment Amt.

Vehicle Make Model Color Year License Plate

References

Name

Street Address

City

State & Zip

Phone Number

Length of Acquaintance

Nearest Relative or Emergency Contact

Name Address

Phone # Relationship

Has applicant filed for bankruptcy within the last 11 years?

Has applicant ever been evicted or been asked to terminate tenancy by an Owner/Manager? ____ Yes ____ No
If yes, please explain:

Has applicant been a party to a lawsuit in the past? ■ No

____ Yes ____
If yes, please explain:

Has applicant been convicted of a crime against a person or real property? ____Yes ____ No
If yes, please explain:

Form provided by the East Bay Rental Housing Association® | www.ebrha.com

Residential Rental Application (Rev. 07/19)
© 2019 All Rights Reserved | Page 2 of 3
 Residential Rental Application

Screening Fee

Each applicant shall pay a nonrefundable screening fee of $ 40.00 . The application Screening fee is not part of a security
deposit, advance fee or rent. Upon request, Applicant may be provided a copy of the consumer credit report for which
Owner/Agent obtained in connection with the Application to rent and will be provided if the credit report is used as the basis of
an adverse action. Applicant herein authorizes the Owner/Agent to use these funds to obtain and review information herein,
criminal background checks, credit checks, and other screening materials and tools.

The credit report will be conducted by: Transunion

If the Property is comprised of one (1) to four (4) dwellings,

a Notice of Default has has not been recorded against the Property.

Agreement & Authorization Signature

The undersigned has read the foregoing and acknowledges receipt of a copy of the application.

Applicant represents the statements are true and correct and hereby authorizes Owner/Agent to verify these items
and obtain credit and/or criminal background checks to be made and to furnish additional credit references or other
legal information upon Owner’s/Agent’s request. Applicant certifies under penalty of perjury that the foregoing is
true and correct. Applicant agrees that the Owner/Agent is authorized to investigate the information that is provided
herein and to inquire and study the information in connection with establishing Applicants qualifications to rent.
Applicant further acknowledges and agrees that misstatements or misrepresentations of the foregoing information is
a non-curable breach of any rental agreement that may be entered into with Owner/Agent. Applicant understands
that any discrepancy or lack of information may result in the rejection of this application. Applicant understands that
this is an application for a residential rental unit and does not constitute an offer to rent or a rental or lease agreement
in whole or part.

The undersigned has received the screening fee as noted above.

Applicant’s Signature: Date:

***Besides this filled out application please also provide a picture of a photo ID and your proof of income***
Owner/Agent’s Signature:Documents can be mailed to the below address, emailed or faxed.
Date:

David@astoundrealestate.com
Bureau of Real Estate License #
Fax: 510-355-0280
Owner/Agent Address:
Postal Annex
785 Oak Grove Rd. Suite E-2 #333 Concord, CA 94518
Owner/Agent Telephone Number:

The $40.00 Application fee per applicant can be paid either by card below or by check/cash/
money order made out to Astound Real Estate and dropped off to the above address:

Name on Card: _________Victoria Haro____________________

5524332767169868
Card #____________________________________ Exp.__11/24______ CVC ___133___
Zipcode____94507_______

Form provided by the East Bay Rental Housing Association® | www.ebrha.com

Residential Rental Application (Rev. 07/19)
© 2019 All Rights Reserved | Page 3 of 3