Need Help? Call 209-546-2600 (Monday to Thursday 9:30AM to 3:30PM)
6141 Lorraine Ave
Email ID, First Name, Last Name & Mobile Number must be entered.
Date of Birth
Drivers License #
Social Sec. No
Second Occupant Information (Occupant above 18 years of age)
Second Occupant First Name
Second Occupant Last Name
Second Occupant Occupation
Second Occupant Monthly Income
Second Occupant Job Address
Second Occupant Phone Number
Second Occupant Date of Birth
Second Occupant DL# / SSN
Second Occupant Relationship to Applicant
Other Proposed Occupants
Relationship to Applicant
State and Postcode
Last Rent Amount Paid
Owner or Agent Name
Owner or Agent Phone
Reason for leaving
Is/Was rent paid in full?
Did you give notice?
Were you asked to move?
Dates of Residency
Monthly Gross Pay
Dates of Employment
References and Emergency Contacts
Next of Kin
Relation to Applicant
By signing this application you grant us permission to communicate with all the contacts if we can't locate you. If you abandon the
tenancy for any reason then you grant us permission to allow your relative listed above to remove all contents of the dwelling on your
How long do you think you would be renting from us?
When would you be able to move in?
Why are you moving from your current address?
Have you ever been served a late rent notice?
Have you ever been served an eviction notice?
Agreement & Authorisation
I believe the statements I have made are true and correct. I hereby authorise verification of information I provided and communication with any and all
names listed on this application. I understand that any discrepancy or lack of information may result in the rejection of this application. I
understand that this is an application for tenancy and does not constitute a rental or lease agreement in whole or part.
Applicant's Name: Date: