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IF ACCEPTED BELOW BY LANDLORD, THIS IS A LEGALLY BINDING CONTRACT.

IF NOT UNDERSTOOD, SEEK ADVICE BEFORE SIGNING.

This is an Application for Lease. Rent is payable in advance. It is understood the Premises are to be used as a single-family residence occupied by no more than the Applicant and Additional Occupants listed in this Application, and that occupancy is contingent upon Premises being vacated by present occupant. Each Applicant is SUBJECT TO approval and acceptance by Landlord and/or representatives, and SUBJECT TO a waiting list. Attach (1) Copy of Driver’s License, and (2) one-month Pay Stubs (or 1040 & Schedule C). After approval, the Applicant(s) shall execute a mutually acceptable Lease. All personal property placed in Premises shall be at Tenant’s risk. Renter’s insurance, which includes Owner as additional insured, is required within thirty (30) days of Lease signing. During Application Process a third-party company will collect a Background Check Fee of $40. If, and only if, Application is accepted, Applicant shall submit a NON-REFUNDABLE Application Processing Fee of $50. PETS, SMOKING AND VAPING ARE NOT ALLOWED.

Address of Property You Are Applying For

Date Your Lease Begins

Monthly Rent

$

Length of Lease

How long do you want to live there?

Personal Information

Applicant First Name

Applicant Middle Initial

Applicant Last Name

Applicant Email

Applicant Phone

Applicant Date of Birth

Applicant Social Security Number

Children and Additional Occupants

First Additional Occupant

First Additional Occupant First Name

First Additional Occupant Middle Initial

First Additional Occupant Last Name

First Additional Occupant Age

First Additional Occupant Relationship to Applicant

Second Additional Occupant

Second Additional Occupant First Name

Second Additional Occupant Middle Initial

Second Additional Occupant Last Name

Second Additional Occupant Age

Second Additional Occupant Relationship to Applicant

Third Additional Occupant

Third Additional Occupant First Name

Third Additional Occupant Middle Initial

Third Additional Occupant Last Name

Third Additional Occupant Age

Third Additional Occupant Relationship to Applicant

Fourth Additional Occupant

Fourth Additional Occupant First Name

Fourth Additional Occupant Middle Initial

Fourth Additional Occupant Last Name

Fourth Additional Occupant Age

Fourth Additional Occupant Relationship to Applicant

Emergency Contacts

First Emergency Contact

First Emergency Contact Full Name

First Emergency Contact Relationship to Applicant

First Emergency Contact Address

First Emergency Contact Phone

Second Emergency Contact

Second Emergency Contact Full Name

Second Emergency Contact Relationship to Applicant

Second Emergency Contact Address

Second Emergency Contact Phone

Third Emergency Contact

Third Emergency Contact Full Name

Third Emergency Contact Relationship to Applicant

Third Emergency Contact Address

Third Emergency Contact Phone

Rental History

Address

City

State

Zip

How long did you reside at that address?

Reason for moving

Rent / Own

What was your Monthly Rent?

$

Name of Your Landlord

Landlord's Phone Number

Employment History

Present Employment

Employer Name

How long have you worked there?

Salary

$

Per

Do you work full time?

Full Time

Part Time

Employer Address

Employer City

Employer State

Employer Zip

Job Title

Supervisor

Supervisor Phone

Previous Employment

Previous Employer Name

How long did you work in Previous Employment?

Previous Employment Salary

$

Per (hour/month)

Did you work Full Time?

Full Time

Part Time

Previous Employer Address

Previous Employer City

Previous Employer State

Previous Employer Zip

Previous Job Title

Previous Supervisor

Previous Supervisor Phone

Bank References

First Bank Account

First Bank Name

First Bank Account Number

First Bank Account Current Balance

Second Bank Account

Second Bank Name

Second Bank Account Number

Second Bank Account Current Balance

Third Bank Account

Third Bank Name

Third Bank Account Number

Third Bank Account Current Balance

Vehicles

First Vehicle

First Vehicle Make

First Vehicle Model

First Vehicle Year

First Vehicle Color

First Vehicle Plate Number

Second Vehicle

Second Vehicle Make

Second Vehicle Model

Second Vehicle Year

Second Vehicle Color

Second Vehicle Plate Number

Additional Information

Have you been evicted or had a judgment by a Landlord issued against you?

Are there any outstanding judgments against you?

Have you declared bankruptcy?

Do you plan to declare bankruptcy?

Have you had property foreclosed upon or given title or deed in lieu of?

Are you currently engaged in a lawsuit?

Are you currently obligated to pay alimony, child support or separate maintenance?

Are you a co-maker or endorser on Note?

Do you currently own any pets?

Are you planning on acquiring any pets?

Do you own or are planning on acquiring a waterbed or an aquarium?

Will you require a visual smoke detector for the hearing impaired?

Verification

I HAVE SEEN THE PREMISES IN PERSON AND MAKE THIS APPLICATION TO LEASE THE PREMISES IN ITS PRESENT PHYSICAL CONDITION.

Authorization

I HEREBY AUTHORIZE LANDLORD AND REPRESENTATIVES, CREDIT BUREAUS AND INVESTIGATIVE AGENCIES HIRED BY LANDLORD, TO CONDUCT AN INVESTIGATION OF THE REFERENCES LISTED ABOVE, OR STATEMENTS WRITTEN ABOVE, OR ANY OTHER DATA OBTAINED FROM ME OR FROM ANY PERSON PERTAINING TO MY CREDIT AND FINANCIAL RESPONSIBILITY, AND TO PERFORM A BACKGROUND CHECK ON ME OR TO HIRE A TENANT SCREENING FIRM TO DO SO. THESE ACTIONS MAY RESULT IN A REPORT ON MY CHARACTER, REPUTATION, PERSONAL CHARACTERISTICS AND CRIMINAL HISTORY. I AGREE TO HOLD LANDLORD AND REPRESENTATIVES HARMLESS, IF THE RESULTS OF THIS SEARCH INCLUDE INCORRECT INFORMATION.

Certification

I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND ACKNOWLEDGE RECEIPT OF A COPY OF THIS APPLICATION.

Applicant's Signature *

Clear

Date Applied *

Application Costs

As part of the Application Process, you will pay a non-refundable $40 charge to a third party (no affiliation) who will obtain a Background Check Report on you.

Only if approved, and at the signing of the Lease, you will pay a one-time non-refundable $50 Application Fee.

Uploads

Upload a copy of your Driver's License (Required)
Upload Pay Stubs (one month) or Form 1040 & Schedule C (Required)
Upload any other information you believe we should be aware of in considering your application.

Upload Driver's License and Pay Stubs (or 1040 & Schedule C) *

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Email Address

[email protected]

Phone Number

571-200-5414

Office Address

Centreville, VA

Office

Centreville, Virginia

Call

571-200-5414

Email

[email protected]