Application
Your Name
Date of Birth
SS#
Telephone Number
Email Address
Re-type Email Address
Spouse's Name
Spouse's Date of Birth
Spouse's SS#
Spouse's Phone
Spouse's Email
Moving From (Address)
City/State/Zip
Reason for Leaving
How you Heard of Us
At Present Address? Own Rent w/ Parents
How Long?
Home Financed By
Rent Paid To
Telephone #
Address
City/State/Zip
Payment (Mortgage/Rent)
Former Street Address (if less than one year)
City/State/Zip
How Long?
Reason for Leaving
Names & ages of other persons who will occupy premises
Have you ever been convicted of a felony? Yes No
If so, state the date and nature of the conviction
Presently Employed by
Position
Supervisor
Salary
Business Address
City/State/Zip
Telephone #
If there are other sources of income you would like us to consider, please list income, source, and person (Banker, Employer, etc.) who we could contact for confirmation.
Per Week Per Month Per Year
Credit References: Banks, Stores, Credit Cards, etc. and Complete List of all debts now owing.
(1) Name Address
Account Monthly Payment
(2) Name Address
Account Monthly Payment
(3) Name Address
Account Monthly Payment

Bank Info

Checking Acct. #
Bank
Address
City/State/Zip
Savings Acct. #
Bank
Address
City/State/Zip

Automobiles

Auto 1

Auto 2

In Case of Emergency

Emergency Contact
Address
City/State/ZIP
Telephone #
Relationship

Pets

Do you own a pet? Yes No
Pet Type
Pet Size
List All

By signing within the box below, I/we agree to the background check necessary for the processing of my/our application and the conditions stated below:

Draw signature w/ mouse

Date: 

Draw signature w/ mouse

Date: 

No pets of any kind are permitted in the leased premises without prior written approval and the execution of a Pet Addendum. A Reservation deposit of $_______________ is hereby made. If accepted, this deposit will be applied to your security deposit at the beginning of your residency and, Applicant(s) ("Applicant") agree(s) to sign the Lease Agreement and Rules and Regulations and other lease addenda delivered to the Applicant. If this Application is disapproved, the full Reservation deposit will be returned to the Applicant. In addition to the Reservation deposit, a non-refundable service fee of $_______________is hereby paid as reimbursement for the expense of verifying the information contained herein. Upon signing of this Application, payment of the deposit and subsequent approval of Applicant by Owner, Applicant requests that the dwelling unit described above be removed from those units available for rental. Applicant understands that this Application for rental, if approved, becomes part of the Lease Agreement, even in the event a lease is not signed. If this Application is approved and Applicant does not enter into the Lease Agreement within forty-eight (48) hours of notification of the approval, Applicant hereby agrees the dwelling unit may be listed as available for lease and Applicant shall be responsible for damages incurred, including loss of rent and sublease fees. As part of the approval process, Applicant understands that an investigative report may be made whereby information is obtained through personal interviews with third parties such as family members, business associates, friends, neighbors and others with whom Applicant is acquainted, or who may have knowledge concerning the information needed. The inquiry is to obtain information on Applicant's character, general reputation, personal characteristics and mode of living, whichever may be applicable. This is to certify that Applicant is of legal age, that the above information is true and correct to the best of my/our knowledge, and in order to induce Owner to consider this Application, I/we hereby authorize the verification of any and all information and the obtaining of such character and financial information and records as may be deemed necessary for approval or rejection of this Application. In the event this Application is accepted and the Lease Agreement is entered into, this Application shall become part of the Lease Agreement and any false information contained herein shall be considered a breach thereof and Owner reserves right to terminate Lease Agreement. Pursuant to Section 55-248.12 of the Code of Virginia (1950) as amended, the applicable section of the Virginia Residential Landlord and Tenant Act, and any and all other applicable federal or state regulations, that Great Eastern Management Company is the authorized managing agent ("Agent") for Owner and that Owner, as referred to in this Application shall be deemed to include Owner, Agent and/or their designated employees and representatives. The Applicant(s) has (have) read, understand(s), and agree(s) to abide by the conditions stated herein.