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Airport Spectrum LAX

Suite #

Name

Title

Email

Social Security#

Driver's License or ID

Date of Birth

What is your phone number?

Secondary phone number?

Residence Address

City

State

Zip Code

Nature of Work

I declare that the foregoing information is true and correct. I hereby authorize Sunny Hills-Palladium, Inc. to verify any and all information and references provided, and to obtain and review my consumer credit report(s) for the purpose of evaluating my financial eligibility to enter into a lease agreement. I further authorize the Landlord to obtain additional consumer credit report(s) in the event any balance becomes past due.

I understand that any material misrepresentation or false statement may result in the immediate termination of any agreement entered into in reliance on such information. I acknowledge that this authorization is given voluntarily and knowingly, without restriction.

I agree to pay a $25.00 credit screening fee.

Type Name

Please Sign:

Signature

Today's Date