Rental Application for Residents and Occupants

Each co-applicant and each occupant over 18 years old must submit a separate application.
Spouses may submit a single application.
Date when filled out:

ABOUT YOU Full name (exactly as on driver's license or govt. ID card) YOUR SPOUSE Full name:
Former last names (maiden and married):
Your street address (as shown on your driver's license or government ID card): Spouse's Social Security #:
Driver's license # and state:
Driver's license # and state: OR govt. photo ID card #:
OR govt. photo ID card #:
Birthdate: Height: Weight:
Former last names (maiden and married):
Sex: Eye color: Hair color:
Your Social Security #:
Are you a U.S. citizen?  Yes  No
Birthdate: Height: Weight:
Present employer:
Sex: Eye color: Hair color:
Address:
Marital Status:  single  married  divorced  widowed  separated
City/State/Zip:
$Are you a U.S. citizen?  Yes  NoDo you or any occupant smoke ?  yes  no
Will you or any occupant have an animal?  yes  no Work phone: ( )

Kind, weight, breed, age: Position:

Date began job: Gross monthly income is over: $
Current home address (where you now live):
Supervisor's name and phone:

City/State/Zip: OTHER OCCUPANTS Names of all persons under 18 and other adults who will
Home/cell phone: ( ) Current rent: occupy the unit without signing the lease. Continue on separate page if more than three.
Email address: Name: Relationship:
Name of apartment where you now live: Sex: DL or govt. ID card # and state:
Current owner or manager's name: Birthdate: Social Security #:
Their phone: Date moved in: Name: Relationship:
Why are you leaving your current residence? Sex: DL or govt. ID card # and state:
Birthdate: Social Security #:
Name: Relationship:
Your previous home address:
Sex: DL or govt. ID card # and state:
Birthdate: Social Security #:
City/State/Zip:
Apartment name: YOUR VEHICLES List all vehicles owned or operated by you, your spouse, or any occupants
Name of above owner or manager: (including cars, trucks, motorcycles, trailers, etc.). Continue on separate page if more than three.

Their phone: Previous monthly rent: $ Make and color of vehicle:

Year: License #: State:
Date you moved in: Date you moved out:
Make and color of vehicle:
YOUR WORK Present employer: Year: License #: State:
Address: Make and color of vehicle:
City/State/Zip: Year: License #: State:
Work phone: ( )
WHY YOU APPLIED HERE Were you referred?  Yes  No. If yes, by whom:
Position:
Name of locator or rental agency:
Your gross monthly income is over: $
Name of individual locator or agent:
Date you began this job:
Name of friend or other person:
Supervisor's name and phone:
Did you find us on your own?  Yes  No If yes, fill in information below:
Previous employer:  On the Internet  Stopped by  Newspaper (name):
Address: Â Rental publication:
City/State/Zip: Â Other:
Work phone: ( )
Position: EMERGENCY Emergency contact person over 18, who will not be living with you:

Gross monthly income was over: $ Name:

Dates you began and ended this job: Address:

Previous supervisor's name and phone: City/State/Zip:

Work phone: ( ) Home phone: ( )
YOUR CREDIT HISTORY Your bank's name, city, state:
Relationship:

List major credit cards: AUTHORIZATION I or we authorize (owner's name)

Other non-work income you want considered. Please explain: CG Bellk or L LC

to obtain reports from consumer reporting agencies before, during, and after tenancy
Past credit problems you want to explain. (Use separate page.)
on matters relating to a lease by the above owner to me and to verify, by all available
YOUR RENTAL/CRIMINAL HISTORY Check only if applicable. Have you, means, the informtation in this application, including income history and other
your spouse, or any occupant listed in this Application ever: Â been evicted or information reported by employer(s) to any state employment security agency. Work
asked to move out? Â moved out of a dwelling before the end of the lease term history information may be used only for this Rental Application. Authority to
without the owner's consent? Â declared bankruptcy? Â been sued for rent? Â been obtain work history information expires 365 days from the date of this Application.
sued for property damage? Â been charged, detained, or arrested for a felony or sex
crime that was resolved by conviction, probation, deferred adjudication, court-
ordered community supervision, or pretrial diversion ? Â been charged, detained, or
arrested for a felony or sex-related crime that has not been resolved by any method? Applicant's signature
Please indicate below the year, location and type of each felony and sex crime other
 than those resolved by dismissal or acquittal. We may need to discuss more facts
before making a decision. You represent the answer is "no" to any item not checked above. Spouse's signature

Applicant must also sign on the next page of this Application.

© 2006, National Apartment Association, Inc. - 5/2006 101 02006 0282 01 Page 1 of 2

Contemplated Lease Contract Information

To be filled in only if the Lease Contract is not signed by resident(s) at time of application for rental.
The National Apartment Association Lease Contract to be used must be the latest version published by the association unless an earlier version is initialed by
resident(s) and attached to this Application. The blanks in the Lease Contract will contain the following information:
• Names of all residents who will sign Lease Contract • Rent to be paid at (check one) X
;
• Prorated rent for:  first month or  second month $ ;
;
CG Be ll ko r LL C • Monthly rental due date ;
• Name of Owner/Lessor
• Late charges due if rent is not paid on or before the: 5 th ;
• Initial late charge $ ; Daily late charge $ 0. 00 ;
;
• Returned-check charge $ 2 5.00 ;
• Property name and type of dwelling (bedrooms and baths)
C h a m b er l ayne Gar d en Ap ts . • (Check one) X
;
• Complete street address • Utilities paid by owner (check all that apply): X
X X
City/State/Zip Ri c hmo n d, V A 2 322 7 ;
• Names of all other occupants not signing Lease Contract (persons under age • You are (check one): X required to purchase personal liability insurance or
 not required to purchase personal liability insurance;
18, relatives, friends, etc.)
• Agreed reletting charge $ ;
;
• Total number of residents and occupants ; • Special provisions regarding parking, storage, etc.: (see attached page if
necessary): Pet Breed res trict ions .
• Our consent necessary for guests staying longer than 15 days;
• Beginning date and ending date of Lease Contract
;
• Total security deposit $ 2 00.0 0 ; Animal deposit $ 10 0.00 ;
• # of keys/access devices for:unit, ; mailbox, ; other, ;
• Total monthly rent for dwelling unit $ ;

Application Agreement
1. Lease Contract Information. The Lease Contract contemplated by the parties is deposits as liquidated damages, and the parties will then have no further obligation to each
attached or, if no Lease Contract is attached, the Lease Contract will be the current other.
Lease Contract noted above. Special information and conditions must be explicitly
noted on an attached Lease Contract or in the Contemplated Lease Contract 8. Completed Application. An Application will not be considered "completed" and
Information above. will not be processed until all of the following have been provided to us (unless
checked): Â a separate Application has been fully filled out and signed by you
2. Application Fee (nonrefundable). You have delivered to our representative an and each co-applicant; Â an application fee has been paid to us; Â an
application fee in the amount indicated below, and this payment partially defrays application deposit has been paid to us. If no item is checked, all are necessary for the
the cost of administrative paperwork. It's nonrefundable except as provided by Application to be considered completed.
applicable law.
9. Non-approval. We will notify you whether you've been approved within 10 days
3. Application Deposit (may or may not be refundable). In addition to any after the date we receive a completed Application. Your Application will be
application fee, you have delivered to our representative an application deposit in considered "disapproved" if we fail to notify you of your approval within 10 days
the amount indicated below. The application deposit is not a security deposit. To the after we have received a completed Application. Notification may be in person or
extent permitted by applicable law, it will be credited toward the required by mail or telephone unless you have requested that notification be by mail. You
security deposit when the Lease Contract has been signed by all parties; OR it will must not assume approval until you receive actual notice of approval. The 10-day
be refunded under paragraph 10 if you are not approved; OR it will be retained time period may be changed only by separate written agreement.
by us as liquidated damages if you fail to sign or attempt to withdraw under
paragraph 6 or 7. 10. Refund after Non-approval. If you or any co-applicant is disapproved or
deemed disapproved under paragraph 9, we'll refund all application deposits
4. Approval When Lease Contract Is Signed in Advance. If you and all within 30 days of such disapproval. Refund checks may be made payable to all
co-applicants have already signed the Lease Contract when we approve the co-applicants and mailed to one applicant.
Application, our representative will notify you (or one of you if there are
co-applicants) of our approval, sign the Lease Contract, and then credit the 11. Extension of Deadlines. If the deadline for signing, approving, or refunding
application deposit of all applicants toward the required security deposit. under paragraphs 6, 9, or 10 falls on a Saturday, Sunday, or a state or federal
holiday, the deadline will be extended to the end of the next day.
5. Approval When Lease Contract Isn't Yet Signed. If you and all co-applicants
have not signed the Lease Contract when we approve the Application, our 12. Notice to or from Co-applicants. Any notice we give you or your co-applicant is
representative will notify you (or one of you if there are co-applicants) of the considered notice to all co-applicants; and any notice from you or your
approval, sign the Lease Contract when you and all co-applicants have signed, co-applicant is considered notice from all co-applicants.
and then credit the application deposit of all applicants toward the required
security deposit. 13. Keys or Access Devices. We'll furnish keys and/or access devices only after: (1)
all parties have signed the contemplated Lease Contract and other rental
6. If You Fail to Sign Lease Contract After Approval. Unless we authorize otherwise documents referred to in the Lease Contract; and (2) all applicable rents and
in writing, you and all co-applicants must sign the Lease Contract within 3 days security deposits have been paid in full.
after we give you our approval in person or by telephone or within 5 days after
we mail you our approval. If you or any co-applicant fails to sign as required, we may 14. Receipt. Application fee (may or may not be refundable): $ 25. 00
keep the application deposit as liquidated damages, to the extent permitted by applicable Application deposit (may or may not be refundable): $ 20 0.00
law, and terminate all further obligations under this Agreement. Total of above application fee and application deposit: $
Total amount of money we've received to this date: $
7. If You Withdraw Before Approval. You and any co-applicant may not withdraw
your application or the application deposit. To the extent permitted by applicable law, 15. Signature. Our representative's signature is consent only to this Application
if you or any co-applicant withdraws an Application or notifies us that you've changed Agreement. It does not bind us to accept applicant or to sign the proposed Lease
your mind about renting the dwelling unit, we'll be entitled to retain all application Contract.

Acknowledgment. You declare that all your statements on the first page of this Application are true and complete. You authorize us to verify same through any
means. If you fail to answer any question or give false information, we may reject the application, retain all application fees and deposits as liquidated damages for
our time and expense, and terminate your right of occupancy. Giving false information is a serious criminal offense. In lawsuits relating to the application or
Lease Contract, the prevailing party may recover all attorney's fees and litigation costs from the losing party. We may at any time furnish information to
consumer reporting agencies and other rental housing owners regarding your performance of your legal obligations, including both favorable and unfavorable
information about your compliance with the Lease Contract, the rules, and financial obligations.

If you're seriously ill or injured, what doctor may we notify? (We're not responsible for providing medical information to or calling doctors or emergency personnel.)
Doctor's name: Doctor's phone: ( )
Important medical information about you in an emergency:
Applicant's Signature: Date:
Signature of Spouse: Date:

Signature of Owner's Representative: Date:

FOR OFFICE USE ONLY

1. Apt. name or dwelling address (street, city): C ha mb erl ayne G ar den Ap ts.
Unit # or type:
2. Person accepting application: Phone: ( 804 ) 266 -3922
3. Person processing application: Phone: ( 804 ) 266 -3922
4. Date that applicant or co-applicant was notified by telephone,
  letter, or  in person of  acceptance or nonacceptance:
Â
(Deadline for applicant and all co-applicants to sign lease is three days after notification of acceptance in person or by telephone, five days if by mail.)
5. Name of person(s) who were notified (at least one applicant must be notified if multiple applicants):
6. Name of owner's representative who notified above person(s):

101 02 0060282 02
© 2006, National Apartment Association, Inc. Page 2 of 2 Virginia/ National Apartment Association Official Form B-06, May 2006