APPLICANT
Location of Rental Unit ______________________ Date of Occupancy Desired _________________
Name (last, first, middle) _____________________________________________________________
Date of Birth _________ Social Security Number ___________________________
Current Address ____________________________________________________________________
Current Phone Number ___________________ How long at current address _________________
Own or Rent _________ Name of Landlord _____________________ Phone _____________
If above less than five years, list other addresses below:
Address City State Zip Years Own/Rent From Whom
_____________________ _____________ ____ _____ _____ ________ _______________
_____________________ _____________ ____ _____ _____ _________ _______________
Marital Status (circle one): Married Single Divorced Separated
Relative Contact: _____________________________________________________
Address, City, State, Zip, Phone ________________________________________________________
Employer _________________________________ Position or Title _________________________
Employer’s Address & Phone __________________________________________________________
How long ____________ Salary (specify monthly or weekly) __________________________
Driver’s License Number _____________________________________________________________
Make of Car _______________________ Year ___________ Color _______________________
Tag Number _________________ State __________ Registered to _______________________
List 2 unrelated references:
Name Years Employer City State Zip Phone
_________________ _____ _________________ _____________ _____ ______ __________
_________________ _____ _________________ _____________ _____ ______ __________
List 2 credit references:
Name Address Acct. No. Balance Monthly Pmt.
______________ _______________________ ______________ ____________ _____________
______________ _______________________ ______________ ____________ _____________
Bank _____________________________ Address _______________________________________
List all current debts:
Name Address Acct. No. Balance Monthly Pmt.
______________ _______________________ ______________ ____________ _____________
______________ _______________________ ______________ ____________ _____________
______________ _______________________ ______________ ____________ _____________
I hereby state that the information provided by me in this application is complete and accurate. I authorize you to verify any
and all information contained in this application and to inquire into my character, general reputation, personal
characteristics, and mode of living, and I release all concerned liability in connection with any information they give. I
acknowledge and agree that in the event I enter into a lease with the Owner, that lease may be canceled by the Owner in the
event any of the information provided by me in this application is inaccurate or incomplete. I understand that the Rules and
Regulations are adopted for the benefit of all Residents and proper operation of the property, and I agree that the residency
will be subject to them.
Signature ____________________________________________
Date ________________________________________________
GUARANTOR’S INFORMATION
Name (last, first, middle) _____________________________________________________________
Date of Birth _________ Social Security Number ___________________________
Current Address ____________________________________________________________________
Current Phone Numbers ___________________ How long at current address _________________
Employer _________________________________ Position or Title _________________________
Employer’s Address & Phone __________________________________________________________
How long ____________ Salary (specify monthly or weekly) __________________________
If self-employed, indicate type of business ________________________________________________
How long in business ___________
Bank _____________________________ Address _______________________________________
Any changes must be reported 5 days
I hereby state that the information provided by me in this application is complete and accurate. I authorize you to verify any
and all information contained in this application. I acknowledge and agree that in the event I enter into an agreement with
the Owner, the lease may be canceled by the Owner in the event any of the information provided by me in this application is
inaccurate or incomplete. I understand that the Rules and Regulations are adopted for the benefit of all Residents and
proper operation of the property, and I agree that the residency will be subject to them.
Signature ____________________________________________
Date ________________________________________________
Scott Hill Phone: (540) 239-7099 FAX (540) 639-2351
456 Atkinson Rd www.nrvrentals.com scott@nrvmailbox.com
Christiansburg VA 24073 Office: 206 W Main St., Radford, VA 24141