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1 VIRGINIAASSOCIATIONOFREALTORS APPLICATIONFORRESIDENTIALLEASE (Thisisalegallybindingcontact.Ifnotunderstood,seekcompetentadvicebeforesigning.) Thepropertywillbeshownandmadeavailabletoallpersonswithoutregardtorace,color,creed,religion,nationalorigin,sex,familial status,handicap,orelderlinessincompliancewithallapplicablefederal,stateandlocalfairhousinglawsandregulations. ThisApplicationforResidentialLease(the Application )ismadeasofthe dayof, byandbetween ( Applicant, individually and collectively) and ( Landlord ) through ( Listing Broker or Agent, who represents Landlord), and ( Leasing Broker, who does or does not representapplicant).iflistingbrokerisengagingindualordesignatedagency,aseparateconsentagreementhasbeenenteredintoby ListingBrokerandApplicant. Applicant hereby applies for a residential dwelling unit (the Dwelling Unit ) located at, Virginia,intheCity/Countyof,foroccupancycommencingon,atan initialmonthlyrentpaymentof Dollars($ ).Allpersonsovertheageof18whowill resideinthedwellingunitmustcompletethisapplication. PLEASEFILLINALLINFORMATIONCOMPLETELY 1. ApplicantInformation. Applicant#1 Applicant#2 Applicant#3 Name SSN/ITIN DateofBirth Home# Work# CellPhone# PresentAddress Years Landlord LandlordAddress LandlordPhone PreviousAddress Years Landlord LandlordAddress LandlordPhone PresentlyEmployedBy VARFORM300Rev.08/11 1of7
2 Applicant#1 Applicant#2 Applicant#3 Howlong? Position Salary(Wk.,Mo.,Yr.) $ $ $ Supervisor Telephone FormerlyEmployedBy Howlong? Supervisor OtherOccupants: Name/Age/Relationship Address: 2. VehicleInformation: Applicant#1 Applicant#2 Applicant#3 NumberofVehicles Make Model License# 3. Pets: Applicant#1 Applicant#2 Applicant#3 Type Breed Color Weight 4. IfyouarepresentlyintheArmedServices,state: Applicant#1 Applicant#2 Applicant#3 Branch Rank Outfit Telephone VARFORM300Rev.08/11 2of7
3 5. OtherIncomeYouWouldLikeLandlordtoConsider: Applicant#1 Applicant#2 Applicant#3 Amount $ $ $ (Wk.,Mo.,Yr.) Source 6. BankorSavingsAccounts: Applicant#1 Applicant#2 Applicant#3 BankName/Address AccountNo. TypeofAccount BankName/Address AccountNo. TypeofAccount BankName/Address AccountNo. TypeofAccount 7. InCaseofEmergencyNotify: Applicant#1 Applicant#2 Applicant#3 Name Address Phone Relationship 8. RentalandCreditHistory: a. Reasonforleavingcurrentresidence: Applicant#1 Applicant#2 Applicant#3 VARFORM300Rev.08/11 3of7
4 b. Haveyoueverbeenrejectedfortenancy?IfYes,pleaseexplain: Applicant#1 Applicant#2 Applicant#3 Yes/ No Yes/ No Yes/ No c. Haveyoueverrefusedtopayrentwhendue,beenadefendantinanunlawfuldetaineractionoreviction,orotherwisebeen suedbyalandlordformattersrelatedtoatenancy? Ifso,pleasegivedetails,andthestatusofanypendingactions: Applicant#1 Applicant#2 Applicant#3 Yes/ No Yes/ No Yes/ No d. Haveyoueverfiledforbankruptcy?Ifso,pleasegivedatesoffilingandstatusofcase: Applicant#1 Applicant#2 Applicant#3 Yes/ No Yes/ No Yes/ No e. Pleasegivethenamesandphonenumbersforthreereferences: Applicant#1 Applicant#2 Applicant#3 Name: Phone#: Name: Phone#: Name: Phone#: Name: Phone#: Name: Phone#: Name: Phone#: Name: Phone#: Name: Phone#: Name: Phone#: VARFORM300Rev.08/11 4of7
5 9. CRIMINALHISTORY:HasanyApplicanteverbeenconvictedof,pleadedguiltyto,orenteredapleaofnocontesttoanyfelony,or toanymisdemeanorforacrimethatinvolvedharmtoanyotherpersonorproperty?iftheanswerisyes,pleasegivealldetails, including the specific offense(s), date(s), sentence(s) and jurisdiction(s) in which the offenses occurred, as well as any informationonthestatusofanycurrentprobation. Applicant#1 Applicant#2 Applicant#3 Yes/ No Yes/ No Yes/ No 10. CHECKIFANYAPPLICANTOWNS: CAMPER MOTORCYCLE BOAT TRUCK TRAILER 11. APPLICATIONFEE/THIRDPARTYCOSTS/APPLICATIONDEPOSIT:EachApplicantmustpayatthetimethisApplicationismadethe following,nonrefundableamounts:i)anapplicationfeeintheamountof,and(ii)paymentforthird partycostsincurredbylandlordintheamountof.inaddition,theapplicantmustpayanapplicationdepositinthe amountof atthetimethisapplicationismade,whichmayberefundabletoapplicant,inaccordancewithsection 12 of this Application.The Application Deposit will convert into the Security Deposit on the Commencement Date of the Lease Agreement. 12. OBLIGATIONTOENTERINTOLEASEAGREEMENT/DAMAGES:UponsubmissionofthisApplicationbyApplicant,Agentreservesthe righttoremovethedwellingunitfromtheavailablerentlist.ifthisapplicationisdeniedbylandlord,theapplicationdepositshallbe refundedtoapplicant.ifthisapplicationisapprovedandapplicantfailstorentthedwellingunit,landlordshallbeentitledtoretain thatpartoftheapplicationdepositequaltolandlord sactualdamagesandexpensesasprovidedinsection :1ofthevirginia ResidentialLandlordTenantAct( VRLTA ). 13. GUARANTY.PleaseprovidethefollowinginformationiftheLeaseAgreementwillbeguaranteed,inaccordancewiththeRental SelectionCriteriaofListingBrokerorLandlord. NameofGuarantor: Relationship: SSN/ITIN: DateofBirth: Address: PhoneNumber: NameofGuarantor: Relationship: SSN/ITIN: DateofBirth: Address: PhoneNumber: VARFORM300Rev.08/11 5of7
6 NameofGuarantor: Relationship: SSN/ITIN: DateofBirth: Address: PhoneNumber: 14. APPLICANT INVESTIGATION: Applicant should exercise whatever due diligence Applicant deems necessary with respect to information on the Dwelling Unit, including without limitation, mold, leadbased paint, pests or insects, and any sexual offenders registered under Chapter 23 (sec 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) or srequest,landlordwillprovideapplicantwithacopyoftheleaseagreementforreview. 15. INFORMATIONCORRECT:EachApplicantherebycertifiesthattheinformationcontainedinthisApplicationistrueandcorrectto thebestofapplicant sknowledgeandbelief.eachapplicantherebyauthorizeslistingbrokertoconductacreditcheckonapplicantand suchbackgroundchecksasdeterminedappropriatebylistingbrokertoverifyinformationprovidedhereinbyapplicantforapprovalor rejectionofthisapplication. 16. OTHERPROVISIONS: WehavereadthetermsandconditionsofthisApplication.WeunderstandthisisabindingcontractseparateandapartfromtheLease Agreement. Applicant#1Signature Applicant#2Signature Applicant#3Signature Date: Date: Date: TypeofID: TypeofID: TypeofID: CopyofPhotoID: Yes/ No CopyofPhotoID: Yes/ No CopyofPhotoID: Yes/ No SIGNATUREOFGUARANTOR: Date: / / SIGNATUREOFGUARANTOR: Date: / / SIGNATUREOFGUARANTOR: Date: / / VARFORM300Rev.08/11 6of7
7 Theundersignedacknowledgesthereceiptofthefollowingfeesanddeposits: Applicant#1 Applicant#2 Applicant#3 Applicationfee:$ Applicationfee:$ Applicationfee:$ CheckNo. orcash CheckNo. orcash CheckNo. orcash ThirdPartyCosts:$ ThirdPartyCosts:$ ThirdPartyCosts:$ CheckNo. orcash CheckNo. orcash CheckNo. orcash AnApplicationDepositintheamountof$,paidbychecknumber,orcash whichshallbedepositedinthelandlordorauthorizedagent sescrowaccountwithinfive(5)daysafterthecommencementdateofthe LeaseAgreement. SIGNATUREOFRecipient: Date: / / LeasingBroker saddress: Phonenumber: Cellphoneorpagernumber: OFFICEUSEONLY ApplicationReceived:Date Time ApplicationReviewedBy Accepted Rejected Withdrawn Applicantnotified;Date Time DISCLOSURES: Ifapplicable,Applicanthasbeenprovidedwiththefollowingdisclosures MilitaryAirInstallation DefectiveDrywall COPYRIGHT 2011bytheVIRGINIAASSOCIATIONOFREALTORS.Allrightsreserved.Thisformmaybeusedonlybymembersingood standingwiththevirginiaassociationofrealtors.thereproductionofthisform,inwholeorinpart,ortheuseofthename "VIRGINIAASSOCIATIONOFREALTORS ",inconnectionwithanyotherform,isprohibitedwithoutpriorwrittenconsentfromthe VIRGINIAASSOCIATIONOFREALTORS VARFORM300Rev.08/11 7of7
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