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CALIFORNIA

A S S O CIATION
OF REALTORS®

APPLICATION TO RENT/SCREENING FEE
(C.A.R. Form LRA, Revised 11/09)

I. APPLICATION TO RENT

THIS SECTION TO BE COMPLETED BY APPLICANT. A SEPARATE APPLICATION TO RENT IS REQUIRED FOR EACH
OCCUPANT 18 YEARS OF AGE OR OVER, OR AN EMANCIPATED MINOR.
Applicant is completing Application as a (check one) n tenant, n tenant with co-tenant(s) or n guarantor/co-signor.
Total number of applicants ____________________________________________________________________________________.

PREMISES INFORMATION

Application to rent property at _______________________________________________________________________ (“Premises”)
Rent: $____________________ per _________ Proposed move-in date ______________________________________________

PERSONAL INFORMATION

T
AF
DR

FULL NAME OF APPLICANT _________________________________________________________________________________
Social security No. _________________________ Driver’s license No. __________________ State _____ Expires ______________
Phone number: Home ________________________ Work __________________________ Other ___________________________
Email _____________________________________________________________________________________________________
Name(s) of all other proposed occupant(s) and relationship to applicant _________________________________________________
__________________________________________________________________________________________________________
Pet(s) or service animals (number and type) ______________________________________________________________________
Auto: Make _________________ Model _____________ Year _______ License No. ____________ State ______ Color ___________
Other vehicle(s): ____________________________________________________________________________________________

In case of emergency, person to notify ________________________________________________ Relationship _________________
Address _____________________________________________________________________ Phone ________________________

Does applicant or any proposed occupant plan to use liquid-filled furniture? n No n Yes Type _________________________________

Has applicant been a party to an unlawful detainer action or filed bankruptcy within the last seven years?

n No

n Yes

If yes, explain _______________________________________________________________________________________________
Has applicant or any proposed occupant ever been convicted of or pleaded no contest to a felony?

n No

n Yes

If yes, explain _______________________________________________________________________________________________
Has applicant or any proposed occupant ever been asked to move out of a residence?

n No

n Yes

If yes, explain _______________________________________________________________________________________________

RESIDENCE HISTORY

Current address _______________________________________ Previous address _______________________________________
City/State/Zip ________________________________________ City/State/Zip __________________________________________
From _____________________ to _______________________ From _____________________ to _________________________
Name of Landlord/Manager ______________________________ Name of Landlord/Manager ______________________________
Landlord/Manager’s phone ______________________________ Landlord/Manager’s phone _______________________________
Do you own this property? n No n Yes
Did you own this property? n No n Yes
Reason for leaving current address _______________________ Reason for leaving this address ___________________________
____________________________________________________ _____________________________________________________
____________________________________________________ _____________________________________________________

EMPLOYMENT AND INCOME HISTORY

Current employer ______________________________________
Employer’s address ____________________________________
Position or title ________________________________________
Employment gross income $ __________________ per ________
Previous employer _____________________________________
Employer’s address ____________________________________
Position or title ________________________________________

The copyright laws of the United States (Title 17 U.S. Code) forbid the unauthorized
reproduction of this form, or any portion thereof, by photocopy machine or any other
means, including facsimile or computerized formats. Copyright © 1991-2009,
CALIFORNIA ASSOCIATION OF REALTORS®, INC. ALL RIGHTS RESERVED.

LRA REVISED 11/09 (PAGE 1 OF 2)

Supervisor ____________________ From _______ To ________
Supervisor’s phone ______________________________________
Phone number to verify employment ________________________
Other $ ________ per _________ Source ____________________
Supervisor ___________________ From _______ To ________
Supervisor’s phone ______________________________________
Employment gross income $ _____________________ per _______
Applicant’s Initials (__________)(__________)
Reviewed by _______ Date _______

APPLICATION TO RENT/SCREENING FEE (LRA PAGE 1 OF 2)

org. This form is available for use by the entire real estate industry. Los Angeles. REALTOR® is a registered collective membership mark which may be used only by members of the NATIONAL ASSOCIATION OF REALTORS® who subscribe to its Code of Ethics. and (ii) obtain credit report on applicant. MANAGER OR AGENT. A CPI inflation calculator is available on the Bureau of Labor Statistics website. or received without the screening fee: (i) the application will not be processed. __________________________________________________________ DRE Lic.). # _____________________ Landlord or Manager or Agent Signature ________________ Date THIS FORM HAS BEEN APPROVED BY THE CALIFORNIA ASSOCIATION OF REALTORS® (C. Applicant has paid a nonrefundable screening fee of $ _____________________________. If application is not fully completed. $ __________________________ for ________________________________________________ (other out-of-pocket expenses).bls. using their sole discretion. A REAL ESTATE BROKER IS THE PERSON QUALIFIED TO ADVISE ON REAL ESTATE TRANSACTIONS.R. $ __________________________ for credit reports prepared by _______________________________________________________.A. NO REPRESENTATION IS MADE AS TO THE LEGAL VALIDITY OR ADEQUACY OF ANY PROVISION IN ANY SPECIFIC TRANSACTION. and $ __________________________ for processing. and (ii) the application and any screening fee will be returned. The California Department of Consumer Affairs calculates the applicable screening fee amount to be $37.Property Address: ________________________________________________________ Name of creditor Name of bank/branch CREDIT INFORMATION Date: __________________ Account number Monthly payment Balance due Account number Type of account Account balance PERSONAL REFERENCES T AF DR Name __________________________________ Address ___________________________________________________________ Phone ____________________ Length of acquaintance __________ Occupation _________________________________________ Name __________________________________ Address ___________________________________________________________ Phone ___________________ Length of acquaintance __________ Occupation _________________________________________ NEAREST RELATIVE(S) Name __________________________________ Address ___________________________________________________________ Phone _________________________________ Relationship ________________________________________________________ Name __________________________________ Address ___________________________________________________________ Phone _________________________________ Relationship ________________________________________________________ Applicant understands and agrees: (i) this is an application to rent only and does not guarantee that applicant will be offered the Premises. and hereby authorizes Landlord or Manager or Agent to: (i) verify the information provided. Applicant represents the above information to be true and complete. California 90020 LRA REVISED 11/09 (PAGE 2 OF 2) Reviewed by _______ Date _______ APPLICATION TO RENT/SCREENING FEE (LRA PAGE 2 OF 2) . IF YOU DESIRE LEGAL OR TAX ADVICE. Published and Distributed by: REAL ESTATE BUSINESS SERVICES.57 as of 2006. Applicant _________________________________________________________ Date ________________________ Time _________ Return your completed application and any applicable fee not already paid to: _________________________________________ Address ________________________________________________ City _________________________ State ______ Zip ________ II. a subsidiary of the California Association of REALTORS® 525 South Virgil Avenue. will select the best qualified applicant. CONSULT AN APPROPRIATE PROFESSIONAL. and (ii) Landlord or Manager or Agent may accept more than one application for the Premises and. The undersigned has read the foregoing and acknowledges receipt of a copy. _________________________________________________________________________________ ________________________ Applicant Signature Date The undersigned has received the screening fee indicated above. It is not intended to identify the user as a REALTOR®. INC. www.00. applied as follows: (The screening fee may not exceed $30. SCREENING FEE THIS SECTION TO BE COMPLETED BY LANDLORD. adjusted annually from 1-1-98 commensurate with the increase in the Consumer Price Index.