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Rental Application – (540) 777-3711

STANDARD LEASE LENGTH IS 2 YEARS, OTHER TERMS MAY BE AVAILABLE UPON REQUEST

Application Fee: $30.00 for one applicant, $40.00 for two or more (non refundable)

Sorry we DO NOT accept cash.

Rental Application Process

1. Rental application must be completed and signed.

2. Provide proof of income for each applicant. This can include:

Two recent pay stubs
A letter from employer
Copies of court ordered income
Disability and/or retirement income statements
Bank statements

3. Provide written rental references for last seven years with phone numbers for verification.

4. Application fee is $3o for one applicant and $40 for more than one applicant.

5. The following checks may be completed for your application:

Background
Credit
Previous Rental History

6. Application fee and last month’s rent must be in two separate money orders or certified funds and purchased from one of the following:

U.S. Postal Service
Wells Fargo Bank
Home Trust Bank
Sun Trust Bank
Hometown Bank
Valley Bank
First Citizens Bank
Union First Market Bank
Freedom First Credit Union
MemberOne Credit Union
Wal-Mart (Money Order)
Kroger (Money Order)

PLEASE FILL OUT COMPLETELY

Additional Forms:

Rental Reference Receipt of Deposit

(Print, fill out, and fax/email back to 540-266-3114/ phonegrh@gmail.com )

Property applying for

Applicant

First Name Middle Name Last Name SSN Phone number Email Facebook Drivers License # Issuing State DOB Number of Dependants

Current home address

Address Suite/Apt City State Zip

Co-Applicant

First Name Middle Name Last Name Relationship to Applicant SSN Phone number Email Facebook Drivers License # Issuing State DOB Number of Dependants

Current home address

Address Suite/Apt City State Zip

Additional Occupants

Other Occupants and Relationship to Applicant/Co-Applicant. Include ages of minor children.

(1) Name Relationship Age
(2) Name Relationship Age
(3) Name Relationship Age
(4) Name Relationship Age
(5) Name Relationship Age

Is either co-applicant, or any anticipated occupant a member of the armed services, reserves or National Guard?

Other Prior Addresses

(Beginning with current or most recent and for the last 7 years)

Current/Most Recent Address

Address City State Zip Landlord Landlord Phone Rent How Long? Reason for leaving

Previous Address 2

Address City State Zip Landlord Landlord Phone Rent How Long? Reason for leaving

Previous Address 3

Address City State Zip Landlord Landlord Phone Rent How Long? Reason for leaving

Previous Address 4

Address City State Zip Landlord Landlord Phone Rent How Long? Reason for leaving

Applicant's Employment History

(Beginning with current or most recent and for the last 7 years)

Current Employer

Employer Name Supervisor Start Date Address City State zip Employer phone Monthly income Hourly rate

Previous Employer 2

Employer Name Supervisor Start Date End Date Address City State zip Employer phone Monthly income Hourly rate

Previous Employer 3

Employer Name Supervisor Start Date End Date Address City State zip Employer phone Monthly income Hourly rate

Co-Applicant Employment History

(Beginning with current or most recent and for the last 7 years)

Current Employer

Employer Name Supervisor Start Date Employer phone Monthly income Hourly rate

Previous Employer 2

Employer Name Supervisor Start Date End Date Employer phone Monthly income Hourly rate

Previous Employer 3

Employer Name Supervisor Start Date End Date Employer phone Monthly income Hourly rate

Other income

Additional regular and current sources of income: SSI, Disability, child support, investments, etc.

(1) Income source Amount
(2) Income source Amount
(3) Income source Amount

Banking/Credit Union Accounts/Available Credit/Other

Bank Name City and State
(1) Current Monthly Payments Monthly payment amount Balance
(2) Current Monthly Payments Monthly payment amount Balance
(3) Current Monthly Payments Monthly payment amount Balance

Vehicles in Possession of Applicant/Co-Applicant

(1) Make/Model Year License Number State
(2) Make/Model Year License Number State

Pets

Do you have any pets?

Personal References

(1) Name Address Phone Relationship
(2) Name Address Phone Relationship

Other

Has the Applicant or Co-Applicant ever been evicted or asked to move out?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever broken a rental agreement or lease contract?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever been late with rent payments or sued for non-payment of rents?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever been sued for damages to a rental property?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever declared bankruptcy?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever had any judgments against you?

Applicant Co-Applicant

Has the Applicant or Co-Applicant ever been convicted of a misdemeanor or a felony, Ex: assault, traffic convictions, offenses related to your pet, or any offense involving the use or abuse of drugs, including alcohol?

Applicant Co-Applicant

If yes to any of the above questions, please give the details below including offense charged, offense convicted of, jurisdiction/court in which conviction occurred, date of conviction, and the circumstances upon which conviction was based.

Emergency Contacts

(1) Name Address Phone Relationship
(2) Name Address Phone Relationship

Next of Kin

Next of kin/nearest relative not living with you

Name Address Phone Relationship

I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE, CORRECT AND COMPLETE; I HEREBY AUTHORIZE LANDLORD OR HIS/HER AGENT TO MAKE, NOW AND DURING ANY TENANCY THAT MAY ENSUE, ANY INQUIRIES/CONTACTS NECESSARY TO EVALUATE/VERIFY THE INFORMATION I HAVE PROVIDED HEREIN, TO INCLUDE INQUIRING WITH THE APPROPRIATE CREDIT CHECKING AUTHORITIES AND/OR JUDICIAL JURISDICTIONS, AND CONTACTING THE REFERENCES WHICH I HAVE LISTED HEREIN. IF I RENT THE IDENTIFIED PREMISES, I UNDERSTAND THAT THE INFORMATION CONTAINED ON THIS FORM AND ON ANY RENTAL AGREEMENT MAY BE MAINTAINED BY LANDLORD FOR UP TO SIX YEARS AFTER I VACATE THE PREMISES, OR AS NEEDED BY LANDLORD TO RECOVER ANY LOSSES ARISING OUT OF SUCH TENANCY. I UNDERSTAND THAT THE LANDLORD MAY AT ANY TIME TERMINATE MY RENTAL AGREEMENT FOR ANY MISREPRESENTATIONS MADE HEREIN.

Applicant

I have read and accept the terms above.

Name Date

Co-Applicant

I have read and accept the terms above.

Name Date

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