Rental Application (please print or type)Single Family House

1719 South Nelson Street,

Arlington, VA 22204

PERSONAL INFORMATION

Date of Application ____________________________________

Name of Applicant ____________________________________ Home Phone Number ___________________________

Social Security Number ____________________________________ Passport Number ___________________________

Driver's License Number ____________________________________ Date of Birth ___________________________

Present Address

Street ____________________________________

City ____________________________________ State _______ Zip __________________

How long have you lived at the present address? ________ Monthly Rental Amount __________________

Name of Current Landlord ____________________________________ Telephone ___________________________

Prior Address

Street ____________________________________

City ____________________________________ State _______ Zip __________________

How long have you lived at the present address? ________

Name of prior landlord ____________________________________ Telephone ___________________________

How many will be living in this house Adults ________ Children ________

Employer _________________________________________________ Position ___________________________

Term of employment ____________________________________

How long have you been with this employer? __________________

What is your annual salary? __________________

Who can be called to verify employment information? ___________________________________________________________

Position ____________________________________ Telephone ___________________________

SPOUSE OR ROOM-MATE INFORMATION

Name of Applicant ____________________________________ Home Phone Number ___________________________

Social Security Number ____________________________________ Passport Number ___________________________

Driver's License Number ____________________________________ Date of Birth ___________________________

Employer _________________________________________________ Position ___________________________

Term of employment ____________________________________ Annual Salary ___________________________

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How long have you been with this employer? __________________

Who can be called to verify employment information? ___________________________________________________________

Position ____________________________________ Telephone ___________________________

BANK INFORMATION

Bank name _________________________________________________ Telephone ___________________________

Street ____________________________________

City ____________________________________ State _______ Zip __________________

Checking Account # ____________________________________ Savings Account # ___________________________

PERSONAL REFERENCES

Name Relationship Telephone

____________________________________ ____________________________________ ___________________________

____________________________________ ____________________________________ ___________________________

____________________________________ ____________________________________ ___________________________

OTHER INFORMATION

Have you ever

Filed for bankruptcy? ____________________________________ If yes, when? __________________

Been served an eviction notice or been asked to vacate a property you were renting? ___________________________

Willfully or intentionally refused to pay rent when due? __________________If yes, when? __________________

I/We declare that the foregoing information is true and correct, and I/we hereby authorize you to conduct an employment and

credit check and to verify our references.

______________________________________________________________________________________________________

Applicant Signature Date

______________________________________________________________________________________________________

Co-Applicant's Signature Date

Please let us know how you learned about this listing… __________________________________________________

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