Housing Application To be considered for one of our rental properties, fill out this form in its entirety and mail or fax it to the address provided. *A copy of the applicant's driver's license is required.
6726 South Seminole Trail, Rochelle, VA 22738 t: 540.948.4263   f: 540.948.7860

I) Personal Information
Name: ____________________________________________ SSN: __________________________
Co-applicant: _______________________________________ SSN: __________________________
Other Occupants: (Include ages of minor children) ________________________________________
________________________________________________________________________________
Current Address: ____________________________________________________________________
Address of Co-applicant (if different): _____________________________________________________
Current Phone Numbers: Home: _______________________     Work: __________________________
Co-applicant’s Home (if different): ______________________    Work: __________________________

II) Previous Rental History
Landlord’s Name: ____________________________________ Phone: ______________________
Address: ___________________________________________ How Long: ___________________

Landlord’s Name: ____________________________________ Phone: ______________________
Address: ___________________________________________ How Long: ___________________

Have you or the co-applicant ever broken a rental agreement or lease contract?
No _____ Yes _____, if yes please explain: ____________________________________________
________________________________________________________________________________

III) Employment
Applicant’s Employer: _____________________________________________________________
Position: _____________________________How Long: _________________________________
Monthly Income: ______________________

Co-applicant’s Employer: __________________________________________________________
Position: _____________________________How Long: _________________________________
Monthly Income: ______________________

IV) Credit References
Name: _________________________________________________________________________
Phone Number: ______________________________ Relationship: _________________________

Name: _________________________________________________________________________
Phone Number: ______________________________ Relationship: _________________________

V) Personal References
Name: _________________________________________________________________________
Phone Number: ______________________________ Relationship: _________________________

Name: _________________________________________________________________________
Phone Number: ______________________________ Relationship: _________________________

NOTE: Applicants must also provide a photocopy of a valid state driver's license.