I have read and agree to the Application Agreement. Click Here to read Application Agreement.
Application Fees are 40.00 per person over the age of 18 in the household.
(NOTE:  An application will not be processed until fees are received.)
Property Information
Property Address:
Date you will take occupancy:
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Date Submitted

11-18-2019
Applicant Information
First:
Middle Initial:
Last:
Date of Birth:
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SSN:
Home Number:
Cell Number:
Email:
Driver License #:

State:
Expires: Click Here
Automobile Information
Make:
Model:
Year:
Color:
License plate#:
State:

Make:
Model:
Year:
Color:
License plate#:
State:

Any other name(s) used (including maiden name): 
Residential History
Current Address
Street1:
Street2:
City:
State: Zip:
Residency: Rent   Own
Previous Address
Street1:
Street2:
City:
State:
Zip:
Residency:
Rent   Own
Employment Information
Employment Status
Full-Time   Part-Time   Retired   Student   Self-Employed   Unemployed  
If Retired, Student, Self-Employed or Unemployed what is your Monthly income?
Current Employer
Employer:
Address:
City:
State:
Zip:
Phone Number:
  Ext:
Supervisor Name:

Supervisor Number:
  Ext:

Your Title/Position:

Monthly Income:
Start Date:
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Previous Employer
Employer:
Address:
City:
State:
  Zip: 
Phone Number:
  Ext:
Supervisor Name:

Supervisor Number:
  Ext:

Your Title/Position:

Monthly Income:
Start Date:
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End Date:
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Applicant Questions
Have you ever been asked to move out of a residence?
Yes   No

Have you ever been party to an eviction?
Yes   No
Are you a registered sex offender?
Yes   No
Have you or any member of your household been convicted or pleaded no contest to a felony?
Yes   No


Do you have liquid furniture? (i.e. waterbed)
Yes   No

Do you have renter insurance?
Yes   No
Have you ever filed bankruptcy?
Yes   No
Have you ever had any judgements?
Yes   No
Do you require a hearing impaired smoke detector?
Yes   No
Pets
Do you have Pets?
Yes   No
Other Occupants
Please list all people who will reside in the residence: 

Emergency Contacts
Emergency Contact
First:
Middle:
Last:
Home Phone:
Cell Phone:
Street1:
Street2:
City:
State: Zip:
Nearest Relative (Not residing in the property.)
First:
Middle:
Last:
Home Phone:
Cell Phone:
Street1:
Street2:
City:
State: Zip:

Financial Information
Bank NameAccount TypePhone
Credit Reference NameAccount TypeBalance




Do you own a home or other real estate? Yes   No

Additional Income SourceMonthly Income
Pension
Social Security and/or SSI
Alimony
Child Support
AFDC/Government Assistance
Unemployment Compensation
Other
Additional Comments or Notes
Application Completion

DISCLOSURE AND AUTHORIZATION

The owner of the property you are applying for carries insurance on the dwelling only.  You must acquire renters insurance for your household goods.  Neither the Agent nor Owner of the property is responsible for damages to your personal property.  You will be required to add Source Realty, LLC as an additional insured under your liability section with a minimum liability of $300,000. 

Each Applicant certifies information provided in this application is true and accurate to the best of their knowledge.  Owner and Agent have Applicant's permission to obtain credit history, public records and verify any information provided for purpose of approval or rejection of this application.  Agent may from time to time verify the information provided in this application by obtaining from third parties, including, without limitation, Credit Reporting Agencies.  Signing this application constitutes Applicant's written authorization of such for the duration of the lease and any renewals thereof.  If any Applicant withholds or gives false information, this application is considered void and the lease agreement may be terminated by the Owner. 

If this Application is approve 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 proved in Section 55-248.6:1 of the Virginia Residential Landlord Tenant Act (VRLTA). Full Security Deposit must be received in certified funds by Agent within (24) twenty four hours after application approval.  The Property remains on the market until the deposit is received.  Application fees are nonrefundable. 

Owner and Agent are pledged to the letter and spirit of U.S. Policy for achievement of equal housing opportunity.  We encourage and support affirmative advertising and marketing programs in which there are no barriers to obtain housing because of race, color, religion, sex, disability, familial status, elderliness or national origin. 

Applicant should execute whatever due diligence Applicant deems necessary with respect to information on the property, including without limitation, mold, lead-based paint, pests or insects, and any sex offenders registered under Chapter 23 (sec 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 www.vsp.state.va.us. 

Each Applicant understands that Source Realty, LLC and its Agent represent the Owner of the property.  By signing below, each applicant hereby authorizes verification of the information provided on this form. 

I, the undersigned Applicant, have read this document in its entirety and by clicking "Apply Now" agree to the terms and conditions of the Application and do hereby swear(or affirm) that the information supplied herein is true and complete, to the best of my knowledge and belief.  I understand this is a binding contract separate and apart from the Lease Agreement. 


APPLICANT SIGNATURE: 




   
Database Info:  HOMEASVA_162364  PropertyManagement