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Rental Application (please print or type) Single Family House 1719 South Nelson Street, Arlington, VA 22204 PERSONAL INFORMATION Date of Application

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Name of Applicant

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Home Phone Number ___________________________

Social Security Number

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Passport Number

___________________________

Driver's License Number

____________________________________

Date of Birth

___________________________

Present Address Street

____________________________________ State

Zip

City

____________________________________

How long have you lived at the present address?

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Name of Current Landlord

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Prior Address Street

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City

____________________________________

How long have you lived at the present address? Name of prior landlord

Employer

Adults

________

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Term of employment

Telephone

State

__________________

___________________________

_______

Zip

__________________

Telephone Children

___________________________ ________

Position

___________________________

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How long have you been with this employer?

__________________

What is your annual salary?

__________________

Who can be called to verify employment information? Position

Monthly Rental Amount

__________________

________

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How many will be living in this house

_______

___________________________________________________________

____________________________________

Telephone

___________________________

SPOUSE OR ROOM-MATE INFORMATION Name of Applicant

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Home Phone Number ___________________________

Social Security Number

____________________________________

Passport Number

___________________________

Driver's License Number

____________________________________

Date of Birth

___________________________

Position

___________________________

Annual Salary

___________________________

Employer

_________________________________________________

Term of employment Page 1 of 2

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How long have you been with this employer?

__________________

Who can be called to verify employment information? Position

___________________________________________________________

____________________________________

Telephone

___________________________

Bank name _________________________________________________

Telephone

___________________________

BANK INFORMATION

Street

____________________________________

City

____________________________________

State

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Savings Account #

Checking Account #

_______

Zip

__________________

___________________________

PERSONAL REFERENCES Name

Relationship

Telephone

____________________________________

____________________________________

___________________________

____________________________________

____________________________________

___________________________

____________________________________

____________________________________

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OTHER INFORMATION Have you ever Filed for bankruptcy?

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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

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