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									Nachman Realty
                                        APPLICATION FOR TENANCY

      Thirty-two dollars ($32.00) non-refundable application fee for each applicant or per married couple.
     All Security Deposits and first month’s rent must be paid by money order or cashier’s checks!

                    Date of Application __________________________________

Application is hereby made to lease the property located at _________________________________,
beginning on the _____________ day of ________________, 20____. Number to occupy ________.

                                          APPLICANT INFORMATION

Name __________________________________                        Name __________________________________
       LAST                 FIRST                    MIDDLE              LAST                         FIRST   MIDDLE

Phone Numbers __________________________                       Phone Numbers __________________________

SS# __________________ DOB ____________                        SS# __________________ DOB ____________

Address_________________________________ Address_________________________________
_______________________________________ _______________________________________

Current Landlord _________________________                     Current Landlord _________________________
Landlord Phone # ________________________                      Landlord Phone # ________________________
How long at above address _________________                    How long at above address _________________
Monthly rent $______________                                   Monthly rent $______________

Previous Address _________________________ Previous Address _________________________
_______________________________________ _______________________________________

                                        EMPLOYMENT INFORMATION

Employer _______________________________                       Employer _______________________________
Address ________________________________                       Address ________________________________
Occupation ______________________________                      Occupation ______________________________
Length of employ _________________________                     Length of employ _________________________
Supervisor ______________________________                      Supervisor ______________________________
Supervisor Phone # _______________________                     Supervisor Phone # _______________________
Salary $___________________ per __________                     Salary $___________________ per __________
Additional Income ________________________                     Additional Income ________________________

Prev/Addt’l Emplyr ________________________                    Prev/Addt’l Emplyr ________________________
Address ________________________________                       Address ________________________________
_______________________________________                        _______________________________________
Occupation ______________________________                      Occupation ______________________________
Length of Employ _________________________                     Length of Employ _________________________
Supervisor’s Phone # ______________________                    Supervisor’s Phone # ______________________


Duty Station _____________________________                     Duty Station _____________________________
Rank/Rate ______________________________                       Rank/Rate ______________________________
End Current Enlist ________________________                    End Current Enlist ________________________
Commanding Officer ______________________                      Commanding Officer ______________________
C.O. Phone _____________________________                       C.O. Phone _____________________________
Home of Record __________________________                      Home of Record __________________________

   Applicant need not disclose alimony, child support or separate maintenance income or it’s source, unless
    applicant wishes it to be considered for the purpose of the Application of Tenancy.

                          Each Office Is Independently Owned & Operated  Equal Housing Opportunity
                                           PLEASE COMPLETE FRONT & BACK

                                                  OTHER OCCUPANTS
                                        (Please list full names of all other occupants)

1. _______________________________________              Relationship _______________________DOB _________________
2. _______________________________________              Relationship _______________________DOB _________________
3. _______________________________________              Relationship _______________________DOB _________________
4. _______________________________________              Relationship _______________________DOB _________________

                                      BANKING AND CREDIT REFERENCES

Bank #1 ________________________________________ Acct# ___________________________________________
Bank #2 ________________________________________ Acct# ___________________________________________

1. ____________________________________________ 2. __________________________________________

                                                 OTHER INFORMATION

Have you rented from CENTURY 21 Nachman Realty before? ________ If so, list address ____________________
1 Vehicle (year/make/model) __________________________________________ Lic# ________________State______
2 Vehicle (year/make/model) __________________________________________ Lic# ________________State _____
Driver’s Lic # ____________________________________________ Expires ________________________ State _____
Have you ever: Filed Bankruptcy? _________ Had a judgement/collection _____________ Been evicted? ____________
Do you have pets? _________ How many? ___________ type/weight _________________________________________
Name, address and phone # of Next of Kin ______________________________________________________________

                                              INSURANCE DISCLOSURE

The owner of the unit you are applying for carries insurance on the building only. Neither the Agent nor the
Owner of the property is responsible for damage to your personal property. Owner and Agent require
Lessee/Tenant to obtain $300,000 in Renter’s Insurance to protect their personal property and liability as an
occupant of the premises and provide a certificate of insurance to the Owner/Agent. By signing this
application the prospective Lessee/Tenant agrees to obtain said Insurance.

Megan’s Law Disclosure: Lessee(s) should exercise whatever due diligence they deem necessary with respect to
information on any sexual offender registered under Chap 23 (§19.2-387 et seq.) of Title 19.2 whether the owner
proceeds under subdivision 1 or 2 of subsection A of §55-519. Such information may be obtained by contacting your local
police department or the Department of State Police, Central Criminal Records Exchange, at (804) 674-2000 or

Lead Based Paint Warning Statement: The United States Environmental Protection Agency (EPA) and the Department of
Housing & Urban Development (HUD) have determined that properties built prior to 1978 may contain lead-based paint,
which can cause serious health problems. This property was _______/was not _____ built prior to 1978.

Lessee hereby acknowledges that Lessor, and or Licensed Broker or Salesperson employed by or affiliated with Lessor,
and any Manager employed by Lessor, are Agents of the Owner of the property. Lessee further acknowledges that
Lessor as required by applicable Virginia Law has made full disclosure of the Agency Relationship.
_______ Owner(s) of the property for lease is (are) a Licensed Virginia Real Estate Broker or Agent.

Lessee hereby acknowledges that Broker will deposit all security deposits made. If Lessee/Tenant decides to withdraw
their application for tenancy after acceptance, fifty percent (50%) of the security deposit will be retained as well as a per
diem amount for each day the property has been held off of the market to cover lost marketing time.

All questions must be answered in full. If any Applicant withholds or gives false information, the Owner may terminate this
Application and the lease agreement. In the event the Lessee fails to enter into and occupy the premises at the time set
forth in effective lease, the Lessor shall retain sums equal to the expenses and damages incurred and furnish Lessee with
an itemized list of same.

Applicant(s) have read the information contained in this Application and certify that the information is true and accurate to
the best of the Applicants’ knowledge. The Owner and Agent have each Applicant’s permission to investigate the credit
record and verify employment, income, reference, and all other information regarding each Applicant.

Applicant’s Signature _______________________________________________ Date ______________________

Applicant’s Signature _______________________________________________ Date ______________________
                              Each Office Is Independently Owned & Operated  Equal Housing Opportunity

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