Tenant Application (Page 2 of 2) in pdf

BANK ACCOUNTS

Savings Account Number: _________________________

Bank/Branch: ______________________________

Checking Account Number: ________________________

Bank/Branch: ______________________________

CREDIT CARDS

Name of Card: __________________________________

Account #: _________________________________

Name of Card: __________________________________

Account #: _________________________________

PERSONAL REFERENCES

NAME

PHONE

RELATiONSHiP

1. _________________________________________________________________________________________

2. _____________________________________________________________________________________

IN CASE OF AN EMERGENCY, PLEASE NOTIFY

NAME

PHONE

RELATiONSHiP

1. _________________________________________________________________________________________

2. _________________________________________________________________________________________

Applicant represents that all the above statements are true and correct and hereby authorizes verification of the above

items, including, but not limited to, obtaining a credit report and agrees to furnish additional credit references upon

request. Applicant consents to allow Property Provider/Manager to disclose tenancy information to previous or

subsequent Property Providers/Managers.

Property Provider received payment from Applicant of $ _________________, which is to be used to screen

Applicant with regard to credit history and other background information. The amount charged is itemized as follows:

1. Actual cost of credit report, unlawful detainer (eviction) search, and/or other reports

$ _____________________

2. Cost of obtaining, processing and verifying screening information

$ ____________________

3. Total fee charged (may not exceed $42.06 per applicant)

$ _____________________

The undersigned is applying to rent housing accommodations designated as:

Unit: _____ Located at:___________________________________________________________________

for the Rental Amount of $ _________________ per _________________, and upon approval of this application

agrees to sign a rental or lease agreement and to pay all sums due, including required security deposit of

$ __________, before occupancy.

Applicant’s Signature: ______________________________________________ Date: ______________

Sample Form

UCSB Community Housing Office /

Tenant Application Page 2