Rental Application

Each individual wishing to reside at this property must complete a separate application.

Please fill in all information completely.

Click to view a sample lease agreement.

Applicant Information

Ownership or Landlord History

Current Residence

Previous Residence


Current Employer

Previous Employer

Other Income

Other income you would like landlord to consider

Other Occupants

Vehicle Information


Armed Services

Emergency Contact

Rental and Credit History

Personal References

Criminal History

Recreational Vehicles

Check if applicant owns:


Other Provisions

Application Fee/Third Party Costs/Application Deposit

Each Applicant must pay at the time this application is made the following, non-refundable amounts:

  1. An Application Fee in the amount of $40.

In addition, the Applicant must pay an Application Deposit in the amount of $0 at the time this Application is made, which may be refundable to Applicant, in accordance with Section 12 of this application. The Application Deposit will convert into the Security Deposit on the Commencement Date of the Lease Agreement.

Obligation to Enter Into Lease Agreement/Damages

Upon submission of this Application by Applicant, Agent reserves the right to remove the Dwelling Unit from the available rent list. If this Application is denied by Landlord, the Application Deposit shall be refunded to Applicant. If this Application is approved and Applicant fails to rent the Dwelling Unit, Landlord shall be entitled to retain that part of the Application Deposit equal to Landlord’s actual damages and expenses as provided in Section 55-248.6:1 of the Virginia Residential Landlord Tenant Act (“VRLTA”).

Applicant Investigation

Applicant should exercise whatever due diligence Applicant deems necessary with respect to information on the Dwelling Unit, including without limitation, mold, lead-based paint, pests or insects, and any sexual offenders registered under Chapter 23 (sec. 19.2-387 et seq.) of Title 19. Information regarding registered sex offenders may be obtained by contacting your local police department or the department of State Police, Central Records Exchange at (804) 674-2000 or Upon Applicant’s request, Landlord will provide Applicant with a copy of the Lease Agreement for review.

Information Correct

Each Applicant hereby certifies that the information contained in this Application is true and correct to the best of Applicant’s knowledge and belief. Each Applicant hereby authorizes Listing Broker to conduct a credit check on Applicant and such background checks as determined appropriate by Listing Broker to verify information provided herein by Applicant for approval or rejection of this Application.

We have read the terms and conditions of this Application. We understand this is a binding contract separate and apart from the Lease Agreement.


I have read and agree to these terms.*