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Address
1623 Indian Hill Blvd
Pomona
CA
91767
Phone
9096701800
701
Form: Rent Application
Your Name
*
Your Email
Your phone number
Your full address
Personal
Number of all occupants
Names and ages of all other occupants
Pets
Vehicle info
Make, Model, Year, Color
Person to notify in case of emergency (not in household)
Name, address, phone, and email
Has applicant been a party to an unlawful detainer action or filed bankruptcy within the last 7 years?
If Yes, explain.
Has applicant or any proposed occupant ever been asked to move out of a residence?
If Yes, explain.
Has applicant or any proposed occupant ever been convicted of or pleaded no contest to a felony within the last 7 years?
If Yes, explain.
Residences
Current Residence
*
Address? From when did you start living at current address? Name and phone of Housing Provider or Landlord?
Reason for leaving current address
*
Previous Residence
Address? From when did you start living at previous address? Until when? Name and phone of Housing Provider or Landlord?
Reason for leaving previous address
Employment and Income History
Current Employer
*
Employer Name? Address? Supervisor and Phone? When did you start with your Current Employer?
Employment Income
*
indicate $/month or $/week
Other income source and information
Previous Employment Income
indicate $/month or $/week
Credit
Current Credits
Creditor Name? Account? Monthly Payment? Balance Due?
Bank Information
Name of Bank/Branch? Type of Account? Account No.? Account Balance?
Personal Information for Credit Check
Date of Birth
*
Open the calendar
Format: mm/dd/yyyy For purpose of credit report
SSN
For purpose of credit report
Driver License Number
*
Any other information you would like to add?
Rent Application
Agree
Applicant understands and agrees that this is an application to rent only and does not guarantee that applicant will be offered the Premises. Housing Provider may receive more than one application for the Premises and Applicant will provide a copy of applicant driver license or other acceptable identification upon request. Applicant represents the above information to be true and complete, and hereby authorizes Housing Provider to verify the information provided; obtain a credit report on applicant and obtain an Investigative Consumer Report on and about applicant. The report may include, but not limited to, criminal background checks, reports on unlawful detainers, bad checks, fraud warnings, and employment and tenant history.
*
SUBMIT
