Campbell BMR Rental Authorization From 2

City of Campbell Affordable Rental

Authorization Form 2

STOP - IMPORTANT MESSAGE

PLEASE HAVE ALL HOUSEHOLD MEMBERS THAT ARE 18 YEARS AND OLDER FILL OUT AND SIGN THIS FORM. ONLY ONE FORM PER HOUSEHOLD IS NEEDED.

I/we certify that the answers below are true to be the best of my knowledge. I/we acknowledge that, if I/we am/are assigned an application number, it can be revoked if any of the information provided proves to be untrue or incorrect.*

I am checking this box to indicate that the above statement is true and applies to me.

How many of your household are 18 years and older?*

1 2 3 4 5

The BMR Program requires us to verify income, assets and other information for all members in the household that are 18 years old and over.

Household Member (Applicant) 1*

First Name

Last Name

Household Member 2*

First Name

Last Name

Household Member 3*

First Name

Last Name

Household Member 4*

First Name

Last Name

Household Member 5*

First Name

Last Name

Household Member 1 (Applicant) Email*

Household Member 2 Email*

Household Member 1 (Applicant) Phone*

Household Member 2 Phone*

Household Member (Applicant) 1 - Social Security Number*

Last four digits

Household Member 2 - Social Security Number*

Last four digits

Household Member 3 - Social Security Number -*

Last four digits

Household Member 4 - Social Security Number*

Last four digits

Household Member 5 - Social Security Number*

Last four digits

Household Memeber (Applicant) 1 - Date of Birth*

Household Member 2 - Date of Birth*

Household Member 3 - Date of Birth*

Household Member 4 - Date of Birth*

Household Member5 - Date of Birth*

Present Address (Where do you live now?)*

Address Line 1

Address Line 2

City

State

ZIP Code

Move In Date*

Move Out Date (leave blank if date is unknown)

Please leave blank if not applicable

Owner/Agent Name*

Owner/Agent Name - Phone Number*

Reason for Moving Out?*

Previous Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Move in Date*

Move Out Date*

Owner/Agent Name*

Owner/Agent Name - Phone Number*

Reason for Moving Out?*

Personal References 1*

First Name

Last Name

Length of Acquaintence (Personal References 1)

Personal References 1 -Relationship*

Personal References 1 - Email*

Personal References 1 - Phone*

Personal References 2*

First Name

Last Name

Length of Acquaintence - (Personal References 2)*

Personal References 2 -Relationship*

Personal References 2 Email*

Personal References 2 Phone*

TBD means "To Be Determined"

The undersigned is applying to rent the residential premises designated as Unit __TBD_____ located at ____TBD_________________ in the City of Campbell, California for the rental period commencing on ___TBD__________, with a monthly base rent of $__TBD_________.Tenant understands that if this application is approved, Applicant will be required to sign a rental/lease agreement and pay all sums due, including required security deposit of $_______TBD____________, before occupancy.

HOUSEHOLD MEMBER'S AUTHORIZATION*

HOUSEHOLD MEMBER'S AUTHORIZATION By checking this box and submitting this form all the Applicant(s) and household members represents and warrants that all the above information is complete, true and correct on this form (and other application forms I/we submit in connection with this rental opportunity), and agrees to furnish additional information (such as credit references) and other documentation upon request. The Applicant and household member(s) understands, acknowledges and agrees that any misstatements or omission or misleading information in this form and Application(s) is grounds for denying the Application and/or terminating any lease agreement. The Applicant and household member(s) authorizes the Owner or its agent/representative (the “Owner Parties”), the City of Campbell and its Administrator, HouseKeys to verify and investigate the information in the Application and to obtain any reports that may include without limitation, a consumer report, an investigative consumer report, credit reports, unlawful detainer (eviction) reports, bad check searches, social security number verification, fraud warnings, other investigative reports, criminal history, previous tenant history, assets, bank accounts, investments, tax returns with the IRS, social security benefits, disability benefits, pensions, alimony, child support, and employment history to be used in connection with review of this application as well as thereafter if any lease entered into, if any. Such reports may come from Consumer Reporting Agencies (as defined in the Fair Credit Reporting Act (FCRA)) or from federal, state, local or any other agencies which contain and/or maintain such records. Applicant consents to the Owner Parties, the City of Campbell and its Administrator, HouseKeys disclosing the information in this Application in connection with the above verification and investigation, including without limitation to any credit reporting agency or other company assisting Owner Parties, the City of Campbell and its Administrator, HouseKeys and waive and release Owner Parties, the City of Campbell and its Administrator, HouseKeys from any liability, expense or damage that is in any way related to this authorization or the information obtained in connection therewith. To process this application, Applicant must pay a screening fee for which Landlord will issue a separate receipt. I, Applicant, and household members understand that the application to rent does not entitle me to the lease of property. Under the FCRA, I/we understand that I/we have the right to inspect my file and to dispute the information reported. I/we understand that if I/we have initiated a "security freeze" on my/our credit information with any of the credit reporting agencies, I/we will promptly lift the freeze for a reasonable time so that my/our credit report may be accessed by the Landlord/Manager; and I/we understand that if I/we fail to do so, the Landlord/Manager may consider this an incomplete application. (CC § 1785.11.2.)

Household Member (Applicant) 1 Signature*

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