1. Roseville & Rocklin Residents

Residence Address:

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* 1. Residence Address:

Unit Type

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* 2. Unit Type

Current Rent Amount:

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* 3. Current Rent Amount:

Todays Date:

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* 4. Todays Date:

Number of Bedrooms & Bathrooms

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* 5. Number of Bedrooms & Bathrooms

Quality of Unit

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* 6. Quality of Unit

The Unit is heated with:

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* 7. The Unit is heated with:

The Stove uses:

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* 8. The Stove uses:

Water Heating:

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* 9. Water Heating:

Owner Paid Utilities

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* 10. Owner Paid Utilities

Accessibility:

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* 11. Accessibility:

Amenities

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* 12. Amenities

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