<p> Blackstone Acres LLC 1950 East Sussex Way Suite #119 Fresno, CA 93726 Phone (559) 224-4558 Fax (559) 224-6075</p><p>APPLICATION TO RENT</p><p>Property Address: ______East Sussex Way Unit # ______, Fresno, CA 93726</p><p>Apt Size: studio / 1 / 2 / 3 Rent Amount: $______Requested Move-in Date:______PERSONAL DATA Name: Date of Birth: / / Other Names Used in the Last 10 Years: Drivers License No: State: US Citizen:  Yes  SSN: - - No Present Address: City: Zip: Phone: ( ) - Cell Phone: ( ) - Landlord: Phone: ( ) - How Long at Present Address? Reason for Moving: Rent Amount: $ Previous Address: How Long at Previous Address? Landlord: Phone: ( ) - Reason for Moving: Rent Amount: $ Any Pets?  Yes  No Type: Waterbed?  Yes  No Aquarium?  Yes  No</p><p>All Other Persons Who Name: ______Relationship: ______DOB______Will Occupy the Unit: Name: ______Relationship: ______DOB______Name: ______Relationship: ______DOB______</p><p>Name: ______Phone: ______In Case of Address: ______Emergency Notify Relationship: ______</p><p>OCCUPATION PRESENT EMPLOYER PREVIOUS EMPLOYMENT</p><p>Occupation</p><p>Employer Business Address </p><p>Business Phone Page 1 of 3 Name of Supervisor Dates of Employment From: To: From: To: GROSS MONTHLY INCOME Base Employment Income: $ ______Other Income: Overtime: $ ______Bonuses/Commissions: $ ______Source: ______Amount: $ ______Dividends/Interest: $ ______Total Employment Income: $ ______</p><p>TOTAL GROSS MONTHLY INCOME $ ACCOUNTS BANK BRANCH ACCOUNT TYPE ACCOUNT NUMBER</p><p>Installment Obligations Balance Due Monthly Payment Car: Credit Cards:</p><p>PERSONAL REFERENCES Name Street Address City Zip Phone</p><p>BACKGROUND INFORMATION Have you ever filed for bankruptcy?  Yes  No Have you ever been evicted or asked to move?  Yes  No Do you have any charges pending against you for any criminal offense(s)?  Yes  No Have you ever been convicted, or plead guilty, or no contest to any criminal offense(s)?  Yes  No Have you ever been convicted of selling, distributing or manufacturing illegal drugs?  Yes  No If you answered yes to any of the above questions, give details and dates ______</p><p>REFERRAL Who should we thank for referring you to us? ______Name ______Address</p><p>Page 2 of 3 Applicant represents that the above is true and It is understood that the Landlord/agent has correct and authorizes Landlord/agent to made no commitment to rent. If applicant is process this application and verify the same. accepted by Landlord/agent and there is a unit Applicant understands that processing shall available, Landlord/agent shall then notify the include an interview, a credit check and applicant that contacting references, employers, or former Landlord/agent will reserve unit Landlords or Agents. The processing of this number______at application is conditional on applicant’s ______in Fresno, payment of $30.00 non-refundable “Processing California until move-in on ______. At which Fee” which is necessary for credit checks, time applicant shall pay the $______criminal background, administrative and balance of Security Deposit and execute a overhead costs. If application is not accepted, Rental Agreement and other necessary Landlord/agent shall notify applicant within documents. If the applicant fails to execute the three (3) business days of the date hereof. Rental Agreement and the other necessary documents within the time allowed, the unit shall no longer be reserved for applicant and ______AM / PM Landlord/agent shall retain the Processing Fee, (Date) (Time) and $______per day damages for lost rent. </p><p>______(Landlord/Agent) Date Signed</p><p>______(Applicant) Date Signed</p><p>Page 3 of 3</p>