Personal Credit Check Form
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Complete Personal Credit Check Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
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1Please send a copy of your credit report. If you don’t have one, fill out the form below
and send us a check for $30.00, made payable to
Thank you.
CB Richard Ellis, Inc.
PERSONAL CREDIT CHECK FORM
PLEASE SELECT A VENDOR:
סEXPERIAN (recommended)
סFIRST AMERICAN REGISTRY
RENTAL UNIT
Street #:___________ Street:_________________________________ Street Type:____________ Unit:_____________
City:____________________________ State:__________ Zip Code:_________________ Rental Amount:$__________
Application Date:__________________________________ Broker Name:______________________________________
APPLICANT
Last Name:__________________________________ First Name:__________________________________ MI:_______
Mother’s Maiden Name:____________________________________ SSN:______________________ DOB:___________
Driver’s License #:________________________________________ State Issued:_______________________________
CURRENT ADDRESS
Street #:___________ Street:_________________________________ Street Type:____________ Unit:_____________
City:____________________________ State:___________ Zip Code:__________________ Since:__________________
Rental Amount:$_____________/month
PREVIOUS ADDRESS
Street #:___________ Street:_________________________________ Street Type:____________ Unit:_____________
City:____________________________ State:___________ Zip Code:__________________ Since:________to________
EMPLOYMENT
Employer:__________________________________________________ Occupation:______________________________
Income:$___________________/month Years at Present Employer:______________________________
OTHER INCOME
Income 1:_________________/month Income 2:_________________/month Income 3:_________________/month
(Spouse)
SPOUSE
Last Name:__________________________________ First Name:__________________________________ MI:_______
SSN:_______________________________________ DOB:________________________________________
OTHER INFORMATION
Co-signer:___________________________________ Model Year of Primary Auto (e.g. 1997):____________
The Fair Credit Report Act (Public Law 91-508, Paragraph 604.2) allows for individuals to give their written instructions or consent to
credit reporting agencies allowing for the retrieval of their consumer credit report. This document is such a consent form. By signing
this form, you are granting CB Richard Ellis, or agents thereof, permission to retrieve your personal credit report.
Signature:___________________________________ Date:________________________________________
FOR INTERNAL USE ONLY
Credit Bureau
Permissible Purpose
Special Services
Criminal Reports
סFirst American Registry
סResident Screening
סSocial Search
סConviction
סTRW/Experian
סEmployment
סRegistry Scorex
[ο Felony Only]
סCBI/Equifax
סArrest*
סTrans Union
סIncarceration*
סTAR Only
* Available in limited areas only
Criminal Search Criteria: סCurrent Address
סPrevious Address
Additional States/Counties:_______________
Manager Approval:_________________________________________
PO #_________________________________
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Parent category: Financial