Rental Application
Separate application required from each applicant age 18 or older.
Date and time received by landlord _____________________________________
Credit check fee _____________________ Received ________________________
This section to be completed by landlord
Address of property to be rented: 715 High Street, Petersburg, VA 23803
Rental Term: [   ] month-to-month   [X]  lease from ____________ to ________________
Amounts Due Prior to Occupancy
First month's rent	$ _____________
Security deposit	$  Same as rent__ 
Credit check fee	$  35.00________    
Other (specify): 	$_____________
TOTAL	$_____________ 	
Applicant
Full Name—include all names you use(d): _________________________________
Home phone: __________________	Work phone: ________________________
Email: ________________________	Social Security number: ________________
Driver's license number/state: __________________________________________
Other Identifying Information: ___________________________________________
Vehicle make: __________	Model: ___________	Color: ________	Year: _______
License plate number/state: _____________________________________________

For Sole Occupancy Only
Rental History
First-time renters: attach a description of your housing situation for the past five years
Current address:	_____________________________________________________
_____________________________________________________
Dates lived at address: ________________	Reason for leaving: ________________
Landlord/manager: ___________________	Landlord/manager's phone: __________
Rent: $_________________________	Security deposit: __________________
Employment History
Name and Address of Current Employer: __________________________________
__________________________________
Phone: ________________________________
Name of supervisor: ____________________	Supervisor's phone: _____________
Dates employed at this job: ______________	Position or title: ________________
Name and Address of Current Employer:__________________________________
__________________________________
Phone: ________________________________
Name of supervisor: ____________________	Supervisor's phone: _____________
Dates employed at this job: ______________	Position or title: ________________
Income
1. Your gross monthly employment income (before deductions):	$__________
2. Average monthly amounts of other income (specify sources):	$__________
_____________________________________________________________________
_____________________________________________________________________
Income continued	TOTAL:	$__________
Miscellaneous
No pets allowed.
No waterbeds allowed.
No smoking allowed inside of residence. 
Have you ever:	Filed for bankruptcy?	[   ] yes	[   ] no	How many times _____
Been sued?	[   ] yes	[   ] no	How many times _____
Sued someone else?	[   ] yes	[   ] no	How many times _____
Been evicted?	[   ] yes	[   ] no	How many times _____
Been convicted of a 	[   ] yes	[   ] no	How many times _____
crime?
Explain any "yes" listed above: ___________________________________________
_____________________________________________________________________
References and Emergency Contact
Personal reference: _______________________	 Relationship: __________________
Address:	_______________________________
_______________________________
Phone: ____________________________
Contact in Emergency: ____________________	 Relationship: __________________
Address:	_______________________________
_______________________________
Phone: ____________________________
_____________________________________________________________________
I certify that all the information given above is true and correct and understand that my lease or rental agreement may be terminated if I have made any material false or incomplete statements in this application. I authorize verification of the information provided in this application from my credit sources, current and previous landlords and employers, and personal references. I give permission for the landlord or its agent to obtain a consumer report about me for the purpose of this application, to ensure that I continue to meet the terms of the tenancy, for the collection and recovery of any financial obligations relating to my tenancy, or for any other permissible purpose.
__________________	________________________________________________
Date	Applicant

Notes (Landlord/Manager):
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________