RENTAL APPLICATION / SCREENING FEE

(C.A.R. Form LRA, Revised 12/24)

PAGE 1 – I. APPLICATION TO RENT

A separate application is required for each occupant 18 years of age or older, or each emancipated minor.

THIS SECTION TO BE COMPLETED BY APPLICANT. A SEPARATE APPLICATION TO LEASE OR RENT IS REQUIRED FOR EACH OCCUPANT 18 YEARS OF AGE OR OVER, OR AN EMANCIPATED MINOR.

Applicant is completing Application to Lease or Rent as (check one) * tenant tenant with co-tenant(s) guarantor/co-signor

Total number of applicants *

2. PERSONAL INFORMATION

B. Date of Birth. For purpose of obtaining credit reports. Age discrimination is prohibited by law.

C. Driver’s license and identification. See section II, paragraph 2C for Social Security Number/Tax Identification Numbers. Such number shall be provided upon request from Rental Property Owner, Authorized Broker or Agent, or Property Manager (“Housing Provider”).

Property address applying for *
Full name of applicant *
Date of birth *
Driver’s license / ID number *
State *
Expires *
Home phone *
Work phone *
Other phone *
Email 1 *
Email 2
Names of all other proposed occupants *
Pets other than service or companion animals: number and type *

Vehicles

Auto make
Model
Year
License no.
State
Color
Other vehicles

Emergency contact

Person to notify *
Relationship *
Address *
Phone *

Screening questions

Does applicant or any proposed occupant plan to use liquid-filled furniture? * Yes No
If yes, type
Has applicant been a party to an unlawful detainer action or filed bankruptcy within the last seven years? * Yes No
If yes, explain
Has applicant or any proposed occupant ever been asked to move out of a residence? * Yes No
If yes, explain
Has applicant or any proposed occupant ever been convicted of or pleaded no contest to a felony within the last seven years? * Yes No
If yes, explain

After completing a credit review, Housing Provider may consider the nature of the felony and the length of time since it occurred so long as the felony is directly related to the applicant’s ability to meet its obligations under the lease terms, and any other relevant mitigating information pursuant to 2 CCR §12266.

3. RESIDENCE HISTORY

	Current residence	Previous residence
Address *
City / State / ZIP
From
Name of housing provider *
Housing provider’s phone *
Do you own this property?	Yes No	Yes No
Reason for leaving *

4. EMPLOYMENT AND INCOME HISTORY

	Current employer	Previous employer
Employer
Employer address
From / to
Supervisor
Supervisor’s phone
Gross income per month
Other income information

Applicant’s initials

* Website note: This online page presents the attached screening form for electronic completion. Required-field indicators, online checkbox behavior, and submission controls are website features; the source form wording is retained.

PAGE 2 – APPLICANT INFORMATION AND AUTHORIZATION

Property AddressDate

5. CREDITORS

	Name of creditor	Account	Monthly payment	Balance due
1
2
3
4

5B. BANKING

	Name of bank / branch	Account no.	Type of account	Account balance
1
2

6. PERSONAL REFERENCES

Name	Address	Phone	Length of acquaintance	Occupation

7. NEAREST RELATIVE(S)

Name	Address	Phone	Relationship

8. APPLICANT UNDERSTANDS AND AGREES

8. Applicant understands and agrees that: (i) this is an application to rent only and does not guarantee that applicant will be offered the Premises; (ii) Housing Provider may receive more than one application for the Premises; and (iii) Applicant will provide a copy of applicant’s driver’s license or other acceptable identification upon request.

Applicant represents the above information to be true and complete, and hereby authorizes Housing Provider to: (i) verify the information provided; (ii) obtain a credit report on applicant; and (iii) obtain an Investigative Consumer Report (ICR) on and about applicant. An ICR may include, but not be limited to, criminal background checks, reports on unlawful detainers, bad checks, fraud warnings, and employment and tenant history. By signing below, you also acknowledge receipt of the attached NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW (C.A.R. form BIRN).

If a screening fee is paid, the applicant will be provided a copy of the credit report obtained by Housing Provider within 7 days of the Housing Provider receiving the report.
If a screening fee is not paid, check the box below if you would like to receive, at no charge, a copy of an ICR or consumer credit report if one is obtained by the Housing Provider whenever you otherwise have a right to receive such a copy under California law.
If an applicant will be receiving a government rent subsidy to assist in the payment of rent, such as a Section 8 voucher, applicant may choose to provide lawful, verifiable, alternative evidence of reasonable ability to pay rather than have Housing Provider rely on a credit report. The applicant shall be given a reasonable time to provide the alternative documentation.
Applicant will be receiving a rent subsidy pursuant to the following government program and elects to provide alternative documentation.

9. Applicant further authorizes Housing Provider to disclose information to prior, current, or subsequent owners and/or agents with whom applicant has had, or intends to have, a rental relationship.

If application is not fully completed, or if section II, 2 is applicable and the application is received without the full screening fee: (i) the application will not be processed, and (ii) the application and any portion of the screening fee paid will be returned.

If a screening fee is not paid, I request a copy of any ICR or consumer credit report when I have a legal right to receive it.
Applicant will be receiving a rent subsidy and elects to provide alternative documentation.
Government program
Alternative documentation provided

Applicant signature – type name *
Date *

Return your completed application and any applicable fee not already paid to:
Realty Savers
9361 Bolsa Ave, Suite 209
Westminster, CA 92683

PAGE 3 – II. PROPERTY INFORMATION AND SCREENING FEE

Property AddressDate

1. PROPERTY INFORMATION

Applicant submits this application for the Premises located at *

Rental amount / rent per month *Proposed move-in date *

2. SCREENING FEE

THIS SECTION TO BE COMPLETED BY HOUSING PROVIDER (applicant may fill in the Premises in paragraph 1A below). A rental unit is available or will be available within a reasonable period of time.

1A. Applicant submits this application to lease or rent for the Premises located at (“Premises”) or any prospective locations which may fit Applicant’s rental criteria.

2. SCREENING FEE. Applicant will provide screening information and fee directly to Housing Provider’s authorized screening service, or Applicant shall pay the screening fee directly to Housing Provider as shown below. Civil Code §1950.6 sets the maximum screening fee that can be charged, as adjusted annually by the Consumer Price Index.

A. Applicant provides screening information and fee directly to the authorized screening service. Yes No
Authorized screening service
B. Applicant pays a screening fee of $ per applicant. Yes No
Total screening fee

$ for credit reportsPrepared by$ for other expenses

Other expense description
Processing fee
Application received with full screening fee amount
Refund / processing option

C. Screening-fee return / application criteria. (1) Housing Provider shall return the entire screening fee if Applicant is not selected for tenancy, regardless of the reason, within seven days of selecting another applicant for tenancy or within 30 days of when the application was submitted, whichever occurs first; OR (2) if Housing Provider has written screening criteria, and that criteria is disclosed to the applicant with the application and the first applicant meeting that criteria is approved for the tenancy, then: (i) Housing Provider shall refund the entire screening fee within 7 days of failing to consider the application if the application is not actually considered; (ii) as an alternative to paragraph 2C(2)(i), Housing Provider may offer to apply the screening fee to another rental unit being offered by the Housing Provider, and may retain the screening fee if the applicant does not meet the established, disclosed criteria; and (iii) Housing Provider may keep the screening fee if the application is considered and the applicant is not accepted because the applicant does not meet the established, disclosed criteria.

D. Applicant shall provide Social Security Number/Tax Identification Number to Housing Provider. The undersigned has read the foregoing section regarding the screening fee and acknowledges receipt of a completed copy.

C. Screening-fee return / application criteria

(1) Housing Provider shall return the entire screening fee if Applicant is not selected for tenancy. Yes No
(2) Housing Provider has written screening criteria disclosed with the application. Yes No
Refund timing / date
Alternative rental-unit option / notes

If the application is received without the full screening fee, the Housing Provider will notify Applicant, will not process the application, and will return the application and any portion of the fee paid. If the Housing Provider collects the fee, a receipt will itemize out-of-pocket expenses and time spent.

Applicant signature – type nameDate

Housing Provider / ByDRE licenseDate

* Website note: No screening fee is collected with this initial application. The displayed $60 total and itemized amounts are locked reference values only, and fee, processing, and refund controls remain disabled until a fee is actually received.

* Website note: The online page leaves applicable fee dates and amounts available only for later processing when the screening-fee section applies.

PAGE 4 – NOTICE REGARDING BACKGROUND INVESTIGATION REPORTS

NOTICE REGARDING BACKGROUND INVESTIGATION REPORTS PURSUANT TO CALIFORNIA LAW
(C.A.R. Form BIRN, Revised 6/23)

The person signing below (on behalf of the Housing Provider, if not the Housing Provider) intends to obtain information about you from an investigative consumer reporting agency and/or a consumer credit reporting agency for the purpose of letting a dwelling. Thus, you can expect to be the subject of investigative consumer reports and consumer credit reports obtained for housing purposes. Such reports may include information about your character, general reputation, personal characteristics and mode of living.

With respect to any investigative consumer report from an investigative consumer reporting agency (CRA), the Housing Provider may investigate the information contained in your rental application and other background information about you, including but not limited to obtaining a criminal record report, eviction report, verifying references, work history, your social security number, and other information about you, and interviewing people who are knowledgeable about you. The results of this report may be used as a factor in making housing decisions. The source of any investigative consumer report, as that term is defined under California law, will be the CRA identified below.

The Housing Provider agrees to provide you with a copy of an investigative consumer report when required to do so under California law.

Under California Civil Code §1786.22, you, with proper identification, are entitled to find out from a CRA what is in the CRA’s file on you, as follows:

In person, by visual inspection of your file during normal business hours and on reasonable notice. You also may request a copy of the information in person. The CRA may not charge you more than the actual copying costs for providing you with a copy of your file.
A summary of all information contained in the CRA’s file on you that is required to be provided by the California Civil Code will be provided to you via telephone, if you have made a written request, with proper identification, for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to you.
By requesting a copy be sent to a specified addressee by certified mail. CRAs complying with requests for certified mailings shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the CRA.

Proper Identification includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. Only if you cannot identify yourself with such information may the CRA require additional information concerning your employment or personal or family history in order to verify your identity.

The CRA will provide trained personnel to explain any information furnished to you and will provide a written explanation of any coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you for visual inspection.

You may be accompanied by one other person of your choosing, who must furnish reasonable identification. A CRA may require you to furnish a written statement granting permission to the CRA to discuss your file in such person’s presence.

The undersigned acknowledges receipt of this Notice Regarding Background Investigation Pursuant to California Law.

Housing Provider
Consumer reporting agency
Agency address
Telephone / fax
Agency email

Applicant signature – type nameDate

Electronic signature agreement *

© 2024, California Association of REALTORS®, Inc. United States copyright law (Title 17 U.S. Code) forbids the unauthorized distribution, display and reproduction of this form, or any portion thereof, by photocopy machine or any other means, including facsimile or computerized formats. THIS FORM HAS BEEN APPROVED BY THE CALIFORNIA ASSOCIATION OF REALTORS®. NO REPRESENTATION IS MADE AS TO THE LEGAL VALIDITY OR ACCURACY OF ANY PROVISION IN ANY SPECIFIC TRANSACTION. A REAL ESTATE BROKER IS THE PERSON QUALIFIED TO ADVISE ON REAL ESTATE TRANSACTIONS. IF YOU DESIRE LEGAL OR TAX ADVICE, CONSULT AN APPROPRIATE PROFESSIONAL.

© 2023, California Association of REALTORS®, Inc. United States copyright law (Title 17 U.S. Code) forbids the unauthorized distribution, display and reproduction of this form, or any portion thereof, by photocopy machine or any other means, including facsimile or computerized formats. THIS FORM HAS BEEN APPROVED BY THE CALIFORNIA ASSOCIATION OF REALTORS®. NO REPRESENTATION IS MADE AS TO THE LEGAL VALIDITY OR ACCURACY OF ANY PROVISION IN ANY SPECIFIC TRANSACTION. A REAL ESTATE BROKER IS THE PERSON QUALIFIED TO ADVISE ON REAL ESTATE TRANSACTIONS. IF YOU DESIRE LEGAL OR TAX ADVICE, CONSULT AN APPROPRIATE PROFESSIONAL. This form is made available to real estate professionals through an agreement with or purchase from the California Association of REALTORS®. It is not intended to identify the user as a REALTOR®. 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.

Published and Distributed by: REAL ESTATE BUSINESS SERVICES, LLC, a subsidiary of the California Association of REALTORS®, 525 South Virgil Avenue, Los Angeles, California 90020.

* Website note: Housing Provider and consumer reporting agency details are prefilled and locked on this website for consistency with the configured screening service.

* Website note: The electronic-signature agreement and typed-name acknowledgment are online submission controls added to support electronic completion.