The property will be shown and made available to all persons without regard to any protected class under federal, state or local fair housing law or regulations, or the REALTOR® Code of Ethics.

This Application for Residential Lease is made as of:

Year:

Applicant:

Landlord:

Through Listing Broker or Agent:

Leasing Broker:

does

does not

represent Applicant.

Dwelling Unit located at:

Virginia, in the City/County of:

For occupancy commencing on:

Initial monthly rent payment of:

PLEASE FILL IN ALL INFORMATION COMPLETELY

1. Applicant Information

	Applicant #1	Applicant #2	Applicant #3
Name
SSN/ITIN
Date of Birth
Home #
Work #
Cell Phone #
Email Address
Present Address
Rental Amount
Years
Landlord
Landlord Address
Landlord Phone
Previous Address
Rental Amount
Years
Landlord
Landlord Address
Landlord Phone
Presently Employed By
How long?
Position
Salary (Wk., Mo., Yr.)
Supervisor
Telephone

Other Occupants (Name/Age/Relationship):

2. Vehicle Information

	Applicant #1	Applicant #2	Applicant #3
Number of Vehicles
Make
Model
License #

3. Animals

	Animal #1	Animal #2	Animal #3
Name of Animal
Type
Breed
Color
Weight

4. If you are presently in the Armed Services, state:

	Applicant #1	Applicant #2	Applicant #3
Branch
Rank
Outfit
Telephone

5. Other Income You Would Like Landlord to Consider:

	Applicant #1	Applicant #2	Applicant #3
Amount (Wk., Mo., Yr.)

6. Bank or Savings Accounts:

	Applicant #1	Applicant #2	Applicant #3
Bank Name/Address
Account No.
Type of Account
Bank Name/Address
Account No.
Type of Account
Bank Name/Address
Account No.
Type of Account

7. In Case of Emergency Notify:

	Applicant #1	Applicant #2	Applicant #3
Name
Address
Phone
Relationship

8. Rental and Credit History

a. Reason for leaving current residence:

c. 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 tenancy? If so, please give details, and the status of any pending actions:

e. Please give the names and phone numbers for three references:

Applicant #1	Applicant #2	Applicant #3
Name:Phone #:	Name:Phone #:	Name:Phone #:
Name:Phone #:	Name:Phone #:	Name:Phone #:
Name:Phone #:	Name:Phone #:	Name:Phone #:

9. 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, or moral turpitude?If the answer is Yes, please give all details, including the specific offense(s), date(s), sentence(s) and jurisdiction(s) in which the offenses occurred, as well as any information on the status of any current probation:

10. SERVICEMEMBERS:

For purposes of this Section 10, a "Servicemember" is defined as a member of the armed forces of the United States or a member of the Virginia National Guard serving on fulltime duty or a Civil Service technicians with a National Guard unit, and "Military Orders" is defined as: (i) a permanent change of station orders to depart thirty-five miles or more (radius) from the location of the Premises; (ii) temporary duty orders in excess of three months' duration to depart thirty-five miles (radius) from the location of the Premises; (iii) a discharge or release from active duty with the armed forces of the United States or from full-time duty or technician status with the Virginia National Guard; or (iv) an order to report to government-supplied quarters resulting in the forfeiture of basic allowance for quarters.

Applicant #1	Applicant #2	Applicant #3
Are you currently a Servicemember? Yes No	Are you currently a Servicemember? Yes No	Are you currently a Servicemember? Yes No
If Yes, do you currently have any pending Military Orders? Yes No	If Yes, do you currently have any pending Military Orders? Yes No	If Yes, do you currently have any pending Military Orders? Yes No

11. CHECK IF ANY APPLICANT OWNS:

12. APPLICATION FEE/THIRD PARTY COSTS/APPLICATION DEPOSIT:

Each Applicant must pay at the time this Application is made the following, non-refundable amounts: i) an Application Fee in the amount of , and (ii) payment for third party costs incurred by Landlord in the amount of . In addition, the Applicant must pay an Application Deposit in the amount of at the time this Application is made, which may be refundable to Applicant, in accordance with Section 13 of this Application. The Application Deposit will convert into the Security Deposit on the Commencement Date of the Lease.

13. OBLIGATION TO ENTER INTO LEASE/ 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 55.1-1203 of the Virginia Residential Landlord Tenant Act ("VRLTA").

14. GUARANTY.

Please provide the following information if the Lease will be guaranteed, in accordance with the Rental Selection Criteria of Listing Broker or Landlord.

Name of Guarantor #1:Relationship:SSN/ITIN:Date of Birth:Address:Phone Number:

Name of Guarantor #2:Relationship:SSN/ITIN:Date of Birth:Address:Phone Number:

Name of Guarantor #3:Relationship:SSN/ITIN:Date of Birth:Address:Phone Number:

15. 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 for review.

16. 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.

APPLICANT #1 SIGNATURE:

Date:

Type of ID:

Copy of Photo ID:

Yes

APPLICANT #2 SIGNATURE:

Date:

Type of ID:

Copy of Photo ID:

Yes

APPLICANT #3 SIGNATURE:

Date:

Type of ID:

Copy of Photo ID:

Yes

SIGNATURES OF GUARANTORS:

SIGNATURE OF GUARANTOR #1:

Date:

SIGNATURE OF GUARANTOR #2:

Date:

SIGNATURE OF GUARANTOR #3:

Date:

RECEIPT OF FEES AND DEPOSITS:

The undersigned acknowledges the receipt of the following fees and deposits:

Applicant #1	Applicant #2	Applicant #3
Application fee: $ Check No. Cash	Application fee: $ Check No. Cash	Application fee: $ Check No. Cash
Third Party Costs: $ Check No. Cash	Third Party Costs: $ Check No. Cash	Third Party Costs: $ Check No. Cash

An Application Deposit in the amount of $, paid by check number, or cash

which shall be deposited in the Landlord or Agent's escrow account within five (5) business banking days after the approval of this Application, if approved.

SIGNATURE OF Recipient:

Date:

LEASING BROKER INFORMATION:

Leasing Broker's Address:

Phone Number:

Cell Phone or Pager Number:

Email:

OFFICE USE ONLY

Application Received: DateTime

Application Reviewed By

Application Status:

Accepted

Rejected

Withdrawn

Applicant notified: DateTime

DISCLOSURES: If applicable, Applicant has been provided with the following disclosures

Military Air Installation

Defective Drywall

VIRGINIA REALTORS®

APPLICATION FOR RESIDENTIAL LEASE

PLEASE FILL IN ALL INFORMATION COMPLETELY

1. Applicant Information

2. Vehicle Information

3. Animals

4. If you are presently in the Armed Services, state:

5. Other Income You Would Like Landlord to Consider:

6. Bank or Savings Accounts:

7. In Case of Emergency Notify:

8. Rental and Credit History

9. CRIMINAL HISTORY:

10. SERVICEMEMBERS:

11. CHECK IF ANY APPLICANT OWNS:

12. APPLICATION FEE/THIRD PARTY COSTS/APPLICATION DEPOSIT:

13. OBLIGATION TO ENTER INTO LEASE/ DAMAGES:

14. GUARANTY.

15. APPLICANT INVESTIGATION:

16. INFORMATION CORRECT:

SIGNATURES OF GUARANTORS:

RECEIPT OF FEES AND DEPOSITS:

LEASING BROKER INFORMATION:

OFFICE USE ONLY

VIRGINIA REALTORS®

APPLICATION FOR RESIDENTIAL LEASE

PLEASE FILL IN ALL INFORMATION COMPLETELY

1. Applicant Information

2. Vehicle Information

3. Animals

4. If you are presently in the Armed Services, state:

5. Other Income You Would Like Landlord to Consider:

6. Bank or Savings Accounts:

7. In Case of Emergency Notify:

8. Rental and Credit History

9. CRIMINAL HISTORY:

10. SERVICEMEMBERS:

11. CHECK IF ANY APPLICANT OWNS:

12. APPLICATION FEE/THIRD PARTY COSTS/APPLICATION DEPOSIT:

13. OBLIGATION TO ENTER INTO LEASE/ DAMAGES:

14. GUARANTY.

15. APPLICANT INVESTIGATION:

16. INFORMATION CORRECT:

SIGNATURES OF GUARANTORS:

RECEIPT OF FEES AND DEPOSITS:

LEASING BROKER INFORMATION:

OFFICE USE ONLY

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