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					                     PRE-RENTAL QUESTIONNAIRE

Instructions: This Pre-Rental Questionnaire is to be completed by all adult
persons 18-years or older, who intend to reside at the subject premises. If
you need additional paper to answer any of these questions, please use
reverse side. Please print legibly and clearly.


1. Your name:                       ________________________________


2. Your present address:            ________________________________

                                    ________________________________

3. Your home telephone #:           _____________

4. Your date of birth:              _____________

5. Place of birth:                  _____________

6. Your social security #:          _____________

7. List all nicknames:              _________________________________

8. Have you ever been
convicted of a crime?               Yes___          No___

9. Convicted of felony?             Yes___          No___

If “yes,” when and for what:        _________________________________

10. Convicted of misdemeanor? Yes___                No___

If “yes,” when and for what:        __________________________________

11. Have you ever filed for a
bankruptcy?                         Yes___          No___

If “yes,” when and why:             __________________________________

12. Have you ever rented
residential property?               Yes___          No___

If “yes,” when and where:           __________________________________
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                                      __________________________________

                                      __________________________________

13. Have you ever been
evicted from your home?               Yes___          No___

If “yes,” when and why:               __________________________________

14. Has an unlawful
detainer lawsuit ever
been filed against you?               Yes___          No___

If “yes,” when and where:             ___________________________________

What resulted from the
unlawful detainer lawsuit?            ____________________________________

15. Have you ever paid
your rent late?                       Yes___          No___

If “yes,” when and why:               __________________________________

16. Did you pay a security
deposit at your last residence?       Yes___          No___

17. What was the amount
of your security deposit?             $_______

18. When you vacated your
last residence, were you
refunded all of your deposit?         Yes___          No___

If “no,” why not?                     __________________________________

19. Do you have any pets?             Yes___          No___

20. Will your pets reside
with you?                             Yes___          No___

21. Please identify all persons
who will live with you at the
subject premises and their
relation to you:                      ___________________________________


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                                  ___________________________________

                                  ___________________________________

22. Occupation:                   ___________________

23. Employer:                     ____________________

24. Employer’s address:           _____________________

25. Employer’s telephone #:       _____________________

26. Gross monthly income:         $________

27. Gross household income:       $________

28. Do you have a checking
account?                          Yes___          No___

If “yes,” which bank:             _______________________

29. Do you have a savings
account?                          Yes___          No___

If “yes,” which bank:             ________________________


        I, ____________________, hereby authorize ________ and/or her
authorized agents to obtain a copy of my credit report from the appropriate credit-
reporting agency and to use my credit report in determining my eligibility for
tenancy of the subject premises. I understand and hereby acknowledge that the
$25.00 fee I am paying is intended for the purpose of obtaining a copy of my
credit report and that the $25.00 fee is non-refundable. I understand and hereby
acknowledge that any negative credit history may result in my disqualification
from rental of the subject premises.



Date:_____, 2004                          By:_________________________




                              Pre-Rental Questionnaire

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