BCVDA

Community Name

Will the Condo/House be purchased?

Yes

Will the Condo/House be rented?

Yes

Are you buying?

Yes
No

Are you renting?

Yes
No

First Name

Middle Name

Last Name

Current Address

City

State

Zip Code

Phone Number

Mobile Phone

Email Address

DOB

SSN

Have you ever been arrested before?

Company Name

Supervisor/HR Contact Name

Supervisor/HR Contact Phone Number

Employment Start Date

Employment End Date

Job Title/Position

Salary

Have you caused any problems?

Are you eligible for rehire?

Landlord Name

Landlord Phone Number

Lease Start Date

Lease End Date (if applicable)

Monthly Rent Amount

Have you caused any problems?

Have you made any late payments?

Do you have any pets? (If so, specific Type / Breed / Weight)

Description

Person's Name

Person's Phone Number

Relationship to you?

Length of Time Known Each Other?

Employment Zip Phone

Have you ever had any problems with this person?

Do they consider you a responsible person?

Do they consider you are of good moral character?

Disclosure

AmeriCheckUSA may search for personal information on you, in regard to your current application for residency, through various databases, which may include, but not limited to, Criminal Records, Eviction Records, Bankruptcies, Liens, Judgements, Lawsuits, etc. AmeriCheckUSA may also obtain a copy of your consumer report, also known as a credit report, through various credit reporting agencies such as Equifax, TransUnion, Experian, which may include your FICO score. AmeriCheckUSA may also conduct personal interviews with your current or prior employers, current or prior landlords, neighbors, friends, or associates to verify information which was submitted on your application. AmeriCheckUSA may share any information obtained, with any person, involved in making a decision about your residency.

Authorization

By signing below, you agree that you have read and understand the foregoing disclosure and hereby authorize AmeriCheckUSA to conduct a full and complete residential background check as described in the above disclosure. You further authorize that AmeriCheckUSA may share any information obtained, with any person, involved in making a decision about your residency.

Disclosure

Authorization

Today's Date

Your Name

Your Signature

Clear Signature