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Victorville
14359 Amargosa, Suite T
Victorville CA, 92392
Office 760.957.7802


Barstow
200 E. Williams Street
Barstow CA, 92311
Office: 760.957.7802

Preliminary Application to Rent/Screening Fee

THIS SECTION TO BE COMPLETED BY APPLICANT, A SEPARATE APPLICATION TO RENT IS REQUIRED FOR EACH OCCUPANT 18 YEARS OF AGE OR OLDER
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Premise Information
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Personal Information
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TELEPHONE
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List Additional Occupants
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In case of Emergency please notify
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Residence History
Current Residence
Previous Residence
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Employment and Income History
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Personal References
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Additional References
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Nearest Relative
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Additional Relatives
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Applicant understand and agrees that: (i) this is an application to rent only and does not guarantee that applicant will be offered the Premises; (ii) Landlord or Manager or Agent may accept more than one application for the Premises and, using their sole discretion, will select the best qualified applicant, and (iii) Applicant will provide a copy of applicant’s driver’s license upon request.
Applicant represents the above information to be true and complete, and hereby authorizes Landlord or Manager or Agent to: (i) verify the information provided; and (ii)obtain a credit report on applicant and other reports., warnings and verifications on and about applicant, which may include, but are not limited to, criminal background checks, reports on unlawful detainers, bad checks, fraud warnings, employment and tenant history. Applicant further authorizes Landlord or Manager or Agent to disclose information to prior subsequent owners and/or agents.


If the application is not fully completed, or received without the screening fee (i) the application will not be processed, and ((ii) the application and any screening will be returned.

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Kenneth D Courtney
HMS Realty/HMS
Broker/Owner Bre#01192730 NMLS#301110 NMLS# 236484
Cell-909-917-2995
Office 760-957-7802
Fax 760-957-7803
www.hmshighdesert.com

Victorville Office

Barstow Office