2. Premises Information

3. Personal Information

(For purpose of obtaining credit reports.Age discrimination is prohibited by law.)

4. Residence History

5. Employment and Income History

6. Credit Information

Name of Creditor Account Number Monthly Payment Balance Due
Name of Bank/Branch Account Number Type of Account Account Balance

7. Personal References

8. Nearest Relative(s)

If application is not fully completed, or received without the screening fee: 1. the application will not be processed, and 2. the application and any screening fee will be returned.

Screening Fee

This section to be completed by Landlord, Manager or Agent.

applied as follows: (The screening fee may not exceed $30.00, adjusted annually from 1-1-98 commensurate with the increase in the Consumer Price Index. A CPI inflation calculator is available on the Bureau of Labor Statistics website, www.bls.gov. The California Department of Consumer Affairs calculates the applicable screening fee amount to be $44.50 as of 2012.)

The undersigned has received the screening fee indicated above.