APPLICATION FOR TENANCY
Application is hereby made to lease the premises at _____________________________________________ beginning on the _______ day of ________ (month). Lease term requested: _________________________ Pet Fee: $____________________ Monthly Rent: $___________________________________
Name: __________________________________________________ SS#: ___________________________ Date of Birth: ______/______/__________ Address: _________________________________________________________________________________ Current Phone #:________________________________ How long at current address: __________________ Cell Phone #:________________________________ E-mail:________________________________________
☐ Rent or ☐Own Monthly Rent: $_________________ Do you have a lease: ☐ Yes ☐No Expiration Date: ______/______/__________ Notice Given: ☐ Yes ☐No Name of current landlord: ____________________________________________________________________ Phone#: ___________________________________ Fax#: __________________________________ Former Address: ___________________________________________________________________________ Name of former landlord: ____________________________________________________________________ Phone#: ___________________________________ Fax#: __________________________________ Do you own real estate: ☐ Yes ☐No If yes, where: _______________________________________________ In case of emergency, notify: Name: (not co-applicant) __________________________________________ Relationship: _______________ Address: _____________________________ Phone #: _________________
List all persons who will occupy the rental premises:
Date of Birth ______/______/__________ ______/______/__________ ______/______/__________ ______/______/__________
EMPLOYMENT INFORMATION
Employer: _________________________________________________________________________________ Employer’s Address: _________________________________________________________________________ Occupation: ____________________________________ Length of Employment: ________________________ Supervisor: _________________________________________ Telephone #: ____________________________ Salary: $________________________________ per ________ (week/month/year) Additional income* amount $__________________ Source ________________________________________
*Applicant need not disclose alimony, child support or separate maintenance income or its source, unless applicant wishes it to be considered for the purpose of the application for tenancy.
If military, complete the following (attach copy of orders/LES):
Duty Station: ___________________________________________ Rank/Rate: _________________________ Report Date: ______/______/__________ End of current enlistment: ______/______/__________
CREDIT INFORMATION
Do you have any judgments and/or collections? ☐ Yes ☐No Have you ever filed for Bankruptcy? ☐ Yes ☐No If yes, provide discharge date: ______/______/__________ Have you ever been sued or evicted for nonpayment of rent? ☐ Yes ☐No Have you ever been subject to a foreclosure? ☐ Yes ☐No Do you have any liens? ☐ Yes ☐No If you have answered yes to any of the above, please explain in detail: ________________________________
BANKING & INSURANCE INFORMATION
Bank: _______________________________________ Account #: __________________________________ Bank: _______________________________________ Account #: __________________________________ Address: ________________________________________________________________________________ Do you have renters insurance? ☐ Yes ☐No
Do you have a waterbed? ☐ Yes ☐No Insurance for waterbed? ☐ Yes ☐No Copy of policy? ☐ Yes ☐No
Do you have any pets? ☐ Yes ☐No How many? __________ Spayed/Neutered? ☐ Yes ☐No
Type(s)/Weight(s): __________________________________ Age(s) of pets: _________________________
Applicant will submit an application fee in the amount of $___________ for the purpose of being considered as a tenant. The application fee is non-refundable, whether or not the applicant becomes a tenant in the premises.
Applicant shall submit an application deposit in the amount of $___________ along with this signed Application for Tenancy. If the applicant does not become a tenant in the premises, the application deposit, less the amount of the Owner’s actual expenses and damages, shall be refunded to the applicant.
Each applicant certifies information provided in this application is true and accurate to the best of their knowledge. The Owner of the premises and the Owner’s Agent have each applicant’s permission to obtain credit history and criminal background information, and verify any information provided. Each applicant also authorizes any current or prior landlords or their agents to release information about each applicant to the Owner and Agent. If any applicant withholds or gives false information, this application is considered void and the owner may terminate the lease agreement.
The Owner of the premises you are applying for carries insurance on the dwelling only. You must acquire renters insurance for your own household goods. Neither the agent nor owner of the property is responsible for damages to your personal property.
Applicant acknowledges that property remains on the market until deposit is received in certified funds along with the signed lease.
Owner and Agent are pledged by the letter and spirit of the U.S. policy for achievement of equal housing opportunity. We encourage and support affirmative advertising and marketing programs in which there are not barriers to obtaining housing because of race, color religion, sex, handicap, familial status, elderliness or national origin.
Megan’s Law Disclosure:
Applicant(s) should exercise whatever due diligence they deem necessary with respect to information on any sex offenders registered under Chapter 23 (19.2-387 et seq.) of Title 19.3. Such information may be obtained by contacting your local police department or the Virginia State Police, Central Criminal Records Exchange, at 804-674-2000 or on the Internet at http://sex-offender.vsp.virginia.gov.sor/.
Each applicant understands that the agent represents the Owner of the premises and acknowledges having received a copy of this application at the time it was submitted.
Applicant’s Signature: ______________________________________________________________________
Applications submitted on: ______/______/__________ at ____________________a.m./p.m.
(Date) (Time)
THANK YOU!
Owner: __________________________________________________________________________________ Tenant: __________________________________________________________________________________ Agent (company): __________________________________________________________________________ Address: _________________________________________________________________________________ Premises: ________________________________________________________________________________ Term: ______________________________________________ Starting Date: ______/______/__________ Ending Date: ______/______/__________ Renewal Period: ________________________________ Renewal Notice Period: ________________________ Rent: $____________________ per month Initial Rent: $ ___________________ Late Date: _______ (days after due date) Late Fee: $_____________________ Default Interest Rate: ________% per annum (not to exceed 12%) Returned Check Charge: $ _______________________ Default Pet Rent: $ _______________________ Security Deposit: $ _______________________ to be held by ☐Agent or ☐ Owner Included Utilities: __________________________________________________________________________
Assignment Fee: $ ________________________ Maximum Occupancy: ___________________ Noise Zone: _______________________________________________________________________________ Accident Zone: ____________________________________________________________________________
Notes: ___________________________________________________________________________________
Revised 6/11/2010
This form has been authorized for use by REALTORS® with the expressed permission of the Hampton Roads REALTORS® Association. Any unauthorized reproduction of this form is strictly prohibited and enforced by U.S. Copyright laws. Copyright © 2010 Hampton Roads REALTORS® Association