Rental Application

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

Please fill in all information completely.

*Property

Applicant Information

* First Name * Last Name * SSN/ITIN * Date of Birth Home Phone Number * Cell Phone Number Work Phone Number * Email

Ownership or Landlord History

Current Residence

* Street Address Suite/Apt * City * State * Zip * Years at this address Landlord Name Landlord Address Landlord Telephone Number

Previous Residence

Street Address Suite/Apt City State Zip Years at this address Landlord Name Landlord Address Landlord Telephone Number

Employment/Income

Current Employer

* Employer Name * How Long? * Position * Annual Salary * Supervisor * Telephone * Work Address

Previous Employer

Employer Name How Long? Supervisor

Other Income

Other income you would like landlord to consider

Source Amount (Per Month)

Other Occupants

* First Name * Last Name * Age * Relationship

Vehicle Information

* Number of Vehicles?

Pets

* Type * Breed * Color * Weight

Armed Services

* Are you presently in the Armed Services?

Emergency Contact

* First Name * Last Name * Address * Relationship

Rental and Credit History

* Reason for leaving current residence *Have you ever been rejected for tenancy?
*Have you ever refused to pay rent when due, been a defendant in an unlawful detainer action or eviction, or otherwise been sued by a landlord for matters related to a tnancy?
*Have you ever filed for bankruptcy?

Personal References

* First Name * Last Name * Phone
First Name Last Name Phone
First Name Last Name Phone

Criminal History

*Has any applicant ever been convicted of, pleaded guilty to, or entered a plea of no contest to any felony, or to any misdemeanor for a crime that involved harm to any other person or property?

Recreational Vehicles

Check if applicant owns:
Camper
Motorcycle
Boat
Truck
Trailer

Guarantor

Will this lease agreement be guaranteed?

Other Provisions

Additional information

Application Fee/Third Party Costs/Application Deposit

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

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 www.vsp.state.va.us. 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.