Neatly complete all information below. All other applicants over the age of 18 must complete and sign their own application.

Primary Applicant ______________________________________Phone #_________________DOB_________

Social Security #_____________________Drivers License #_____________________State_______Exp._______

Current Address__________________________________City_________________State_____Zip____________

Current Landlords Name________________________________________Phone #_________________________

How long at this address_______Reason for leaving_________________________________________________

Previous Address_________________________________City_________________State_____Zip____________

Previous Landlords name________________________________________Phone #________________________

How long at this address_______Reason for leaving_________________________________________________

Auto Yr._____Make_____________Model___________________State/License plate #_____________________

Present Employer____________________________Position_________________Phone #___________________

Employers Address______________________________City__________________State_____Zip____________

Phone #________________How long at this job_______Mo Income____________________________________

Other Income/sources__________________________________________________________________________

Co-applicant___________________________________________________________________DOB_________

Social Security #_____________________Drivers License #_____________________State_______Exp._______

Present Employer____________________________Position_________________Phone #___________________

Employers Address______________________________City__________________State_____Zip____________

Phone #________________How long at this job_______Mo Income____________________________________

Other Income/sources__________________________________________________________________________

Number and type of pets____________________Have either of you ever been party to an eviction? [ ] Yes [ ] No

Total number of adults___________Total number of children living with you under the age of 18_____________

Names and relations of all other applicants_________________________________________________________

___________________________________________________________________________________________

I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for tenet screening as may be necessary in arriving at a tenant decision. I understand that the landlord may terminate any rental agreement entered into for any misrepresentation made above.

Signature_________________________________________________________Date_____________

Signature_________________________________________________________Date_____________

Received from applicants the non-refundable sum of $_______dollars to pay for tenant screening services from A.C.B.

Accurate Credit Bureau Phone 626 798 6670 Fax 626 398 0642 www.accuratecredit.com