LIFE REALTY, INC.
Office: (510) 380-8682 • Fax: (510) 743-4143 • http://www.liferealtyonline.com
APPLICATION TO RENT OR LEASE
PERSONAL INFORMATION
Name: Social Security #: Date of Birth:
Driver’s License #: State Issued: Home Phone:
Email: Marital Status: Cell Phone:
Text
RENTAL HISTORY
Present Address: City: State: Zip:
How long at this address? Owner’s Name: Phone #:
Previous Address: City: State: Zip:
How long at this address? Owner’s Name: Phone #:
EMPLOYMENT HISTORY
Employer: Position: Current Previous
How long at this employer? Supervisor: Phone #:
Address: City: State: Zip:
Employer: Position: Current Previous
How long at this employer? Supervisor: Phone #:
Address: City: State: Zip:
FINANCIAL HISOTRY
Gross Monthly Income: Source:
Any Additional Income: Source:
Bank Name: Checking Savings Balance:
Bank Name: Checking Savings Balance:
BACKGROUND INFORMATION
Have you ever been evicted? Yes No
If yes, please explain:
Have you ever filed for Bankruptcy? Yes No
If yes, please explain:
Have you ever been convicted of a felony? Yes No
If yes, please explain:
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LIFE REALTY, INC.
Office: (510) 380-8682 • Fax: (510) 743-4143 • http://www.liferealtyonline.com
APPLICANT:
PERSONAL REFERENCES
Reference Name: Relationship: Phone #:
Address: City: State: Zip:
Reference Name: Relationship: Phone #:
Address: City: State: Zip:
HOUSEHOLD COMPOSITION
Name and age of all adults in household:
Name and age of all children in household:
Does anyone in the house smoke? Yes No Pets? Type:
I AM APPLYING FOR (PROPERTY ADDRESS):
DESIRED MOVE-IN DATE:
I certify that all information given above is true and correct and hereby authorize Landlord and/or Landlord’s agent to contact all references
named in this application, and to conduct a credit review, including obtaining my credit report from any authorized credit reporting agency.
I understand that this is an application to rent and does not constitute a rental or lease agreement in whole or in part. I further understand
that there is a non-refundable screening fee of $ 30 to cover the cost of processing my application and that I am not entitled to a
refund regardless of whether I am approved for the rental(s). I am aware that any false, fraudulent or misleading information contain herein
may be grounds for denial of tenancy and/or forfeiture of my rental or lease agreement.
Applicant: Date:
APPLICATION INSTRUCTIONS
Step 1: Each household member over 18 years of age must fill out an application
Step 2: Each household member over 18 years of age must submit a copy of driver’s license or ID card
Step 3: Each household member whose income is used for qualifying must submit:
• Two month’s bank statements
• Two month’s paystubs
Step 4: There is a $30 application fee for each qualifying member ($15 if you are submitting a recent
credit report). Pay online at http://liferealtyonline.com (Click on “Make Payment”)
Step 5: Fax completed applications to 510-743-4143 or email to application@liferealtyonline.com
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