October Investments, LLC RENTAL APPLICATION The undersigned hereby makes an application to rent the following property:. Anticipated move-in date of at a monthly rent of $ and security deposit of $ Applicant was referred to Landlord by: PLEASE TELL US ABOUT YOURSELF Full Name Home Phone ( Other Phone ( Cell Phone ( ) ) ) Emergency Contact Name and Number ( ) of Birth Height Weight Eye Color Hair Color Marital Status Citizenship Social Security No. Driver s License No. Email Address: Co-Applicant Name Co-Applicant of Birth Social Security # Driver s License # Names of Dependents Dependents of Birth List All Pets Name all other persons who will occupy the Property: Page 1 of 5
PLEASE GIVE RESIDENTIAL HISTORY (LAST 3 YEARS) Current Address Apt# City State Zip Month/Year Moved In Move-Out Reasons for Leaving Rent $ Landlord/Agent Phone ( ) Previous Address (last 3 years) Reasons for Leaving Rent $ Landlord/Agent Phone ( ) PLEASE DESCRIBE YOUR CREDIT HISTORY Have you declared bankruptcy in the past seven (7) years? Have you ever been evicted from a rental residence? Have you had two or more late rental payments in the past year? Have you ever willfully or intentionally refused to pay rent when due? PLEASE PROVIDE YOUR EMPLOYMENT INFORMATION Your Status: Full Time Part Time Student Unemployed Current Employer Address: Supervisor s Name: Phone ( ) s employed Employed as Salary $ per, (hourly, weekly, bi-weekly or monthly). Previous Employer Address: Supervisor s Name: Phone ( ) s employed Employed as Salary $ per (hourly, weekly, bi-weekly or monthly). If hourly how many hours per week. If you have other sources of income that you would like us to consider, please list income, source, and person (banker, employer, etc.) who we may contact for confirmation. You do not have to reveal alimony, child support, or spouse's annual income unless you want us to consider it in this application. Amount $ Source/Contact Name Page 2 of 5
PLEASE LIST YOUR REFERENCES Banking Accounts: Checking Account Name Account Number Routing # Savings Account Name Account Number Personal Reference or Emergency Contact: Name Address Phone Relationship Driver's License: Your Driver's License Number State List all vehicles to be parked on the Property: List all pets to be kept on the Property: Type & Breed Name Color Weight Age Gender Note for each if they are neutered, declawed and Rabies shots are current. Will any waterbeds or water-filled furniture be on Property? Does anyone who will occupy the Property smoke? Will Applicant maintain renter s insurance? If Applicant is in the military, is Applicant serving under orders Limiting Applicant s stay to one year or less? Has applicant ever: Been evicted? Been asked to move out by a Landlord Breached a lease or rental agreement Filed for bankruptcy? Lost property in a foreclosure? Had any credit problems? Been convicted of a crime? Is any occupant a registered sex offender? Are there any criminal matters pending against any occupant? Yes No Page 3 of 5
ADDITIONAL INFORMATION: Please give any additional information that might help owner/management evaluate this application? I hereby apply to lease the above described premises for the term and upon the set conditions above set forth and agree that the rental is to be payable the first day of each month in advance. I hereby deposit $ as earnest money to be refunded to me if this application is not accepted in 5 business banking days. Upon acceptance, this deposit shall be retained as the security deposit. When so approved and accepted, I agree to execute a lease for months before possession is given and to pay the balance of the security deposit prior to the move in date. If the application is not approved or accepted by the owner or agent, the deposit will be refunded, the application hereby waiving any claim for damages by reason of non-acceptance which the owner or agent may reject. Unless agreed otherwise in writing, the Property remains on the market until a lease is signed and Landlord may continue to show the Property to other prospective tenants and accept another offer. Fees: Applicant submits a non-refundable fee of $40 for processing and reviewing this application. The above information, to the best of my knowledge, is true and correct. Please sign: Name of Applicant Page 4 of 5
AUTHORIZATION Release of Information Authorization & Representation: Applicant authorizes Landlord and Landlord s agent, at any time before, during, or after any tenancy, to: (1) obtain a copy of Applicant s credit report; (2) obtain a criminal background check related to Applicant and any occupant; and (3) verify any rental, employment, or criminal history or verify any other information related to this application with persons knowledgeable of such information. Applicant represents that the statements in this application are true and complete. Applicant understands that providing false or inaccurate information is grounds for rejection and a breach of any lease. Name (please print) Name of Applicant I, (Applicant), have submitted an application to lease a property located at (address, city, state, zip). The landlord or landlord s representative who will verify information in the application is: Ben Mahler October Investments, LLC P.O. Box 125 Newbury Park, CA 91319-0125 805 498-0376 m.prod3@verizon.net I give my permission: To my current and former employers to release any information about my employment history to the above-named person; To my current and former landlords to release any information about my rental history to the above-named person; To my bank, savings and loan, or credit union to provide a verification of funds that I have on deposit to the above-named person; and To the above-named poerson to obtain a copy of my consumer report (credit report) from any consumer reporting agency and to obtain criminal background information about me. Applicant s Signature Page 5 of 5