1. Roseville & Rocklin Residents

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* 1. Residence Address:

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* 2. Unit Type

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* 3. Current Rent Amount:

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* 4. Date rented

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* 5. Number of Bedrooms & Bathrooms

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* 6. Quality of Unit

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* 7. Restricted rent

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* 8. On-site owner/manager

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* 9. The Unit is heated with:

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* 10. The Stove uses:

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* 11. Water Heating:

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* 12. Owner Paid Utilities

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* 13. Accessibility

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* 14. Amenities (please check all that apply)

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