Transcript
Receipt for Prospective Resident Screening – Credit Check Fees California Civil Code §1950.6
Applicant Name(s): Phone No.: Address: City:
Date:
State:
Zip:
Owner/Agent received an Application Fee in the amount of $
from Applicant (listed above) Via:
□ Check #_________; □
Credit Card #________________; □ Cash; □ Money Order/Cashier’s Check #________ to cover the costs associated with obtaining and processing information about Applicant in order to verify information submitted on the application to rent for the rental property located at: Premises
Unit #
City:
State:
Zip:
NON-REFUNDABLE FEE: Applicant understands that this Application Screening Fee is a NON-Refundable fee, to cover the cost of obtaining information about Applicant; including the cost of obtaining personal reference checks, consumer credit reports, criminal background checks and other similar information, such as tenant screening service reports regarding past unlawful detainer litigation. This document shall also serve as a screening fee receipt required by law. SCREENING FEE RECEIPT: This Application Screening Fee collected above will be used by Owner/Agent to cover the following costs: 1. Cost to purchase personal reference checks, consumer credit reports and/or other tenant screening service reports regarding prior unlawful detainer actions: $_____________ 2. Processing costs (including the reasonable value of time spent by Owner/Agent and/or his agent in obtaining, reviewing & verifying the information obtained)*: $_____________ 3.
Total fee charged
$
It is understood that the Application Screening Fee is not to be considered a deposit for security or advance fee on the Premises. Applicant has the right to request that Owner/Agent provide a copy of any consumer credit report for which all or any portion of the Application Screening Fee was used to obtain. AUTHORIZATION/ VERIFICATION OF ACCURATE INFORMATION PRESENTED: By signing below Applicant authorizes Owner/Agent to use the funds stated above to verify any and all information presented to Owner/Agent in regards to his/her applying to rent Premises, including, but not limited to, criminal background checks, credit checks and other resident screening methods. Applicant warrants that all information provided to Owner/Agent is true and accurate. Applicant(s): _____________________________________ Date___________________ _____________________________________ Date___________________ _____________________________________ Date___________________ _____________________________________ Date___________________ Owner/Agent: _____________________________________ Date___________________ *The screening fee may not exceed the landlord's out-of-pocket costs of gathering information concerning Applicant, including, but not limited to, the cost of using a tenant screening or consumer credit reporting service and the reasonable value of time spent by the landlord (or landlord's agent) in obtaining the information. This fee shall not exceed $30 (adjusted annually from 1-1-98 commensurate with the increase in the Consumer Price Index). This Application Credit Check/Screening Fee Receipt is to be personally delivered or mailed by Owner/Agent to Applicant.
Form 120 © 2012 Page 1 of 1
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