RENT APPLICATION

A-1 Rentals Inc.

770 Wytheview Drive

Wytheville , VA 24382

276*620*2616

WWW.Propertiesforrent.net Email A1Rentalsinc@gmail.com

Completed Applications are required for ALL proposed adult occupants, 18 years of age or older. Any incomplete or inaccurate information will result in rejection of this application.

Last Name First Name Middle			Social Security Number
Drivers License Number / State	Date of Birth	Home Phone	Other Phone
Current Address City State Zip			Current Rent
Property Location	Move in date	Name of present landlord.	Phone
Est. Move out date	Reason for Moving
Prior Address City State Zip			Prior Rent
Apartment Name	Move in date	Name of landlord.	Phone
Move out date	Reason for Moving

PLEASE LIST ALL OTHER PROPOSED OCCUPANTS BELOW:

Name/age	Name/age
Name/age	Name/age

EMPLOYMENT INFORMATION

Current Employment Per Month / Year Gross Income			Other Income Amount Month/Year Source/Type
Current Employer Name		Employer Address
Position	Date Started			Supervisor Name	Phone
Prior Employer Name		Employer Address
Position	Date Started			Supervisor Name	Phone

VEHICLE INFORMATION: ALL VEHICLES PARKED ONSITE MUST BE LICENSED AND OPERABLE

Make			Model		Yr	License # / State
Make			Model		Yr	License # / State
	Have you willfully refused to pay rent when due?	Have you ever been evicted or asked to move?		If so, Why?

Have you ever been convicted of a felony?	If so, for what, when and where?
Do you have or intend to get pets?	Have you, or do you intend to possess, sell or use illicit drugs or narcotics in your residence?
Have you ever filed for bankruptcy?		Will you have Liquid filled furniture (waterbed)?

PLEASE LIST ALL CREDITORS, IF MORE THAN 7 USE ADDITIONAL SHEET (S)

CREDITORS NAME TOTAL $ AMOUNT MON. PAYMENT CURRENT? Y/N PHONE NUMBER

PERSONAL REFERENCES/ EMERGENCY INFORMATION

NAME ADDRESS CITY PHONE NUMBER RELATIONSHIP

I hereby state and represent 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. I release all concerned from any 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 the lease may be canceled by the owner in the event any of the information provided by me in this application is materially inaccurate or incomplete. I understand that the policies and regulations are adopted for the benefit of all residents and proper operation of the property. I agree that my residency will be subject to them. I authorize B & B Realty, Inc / A-1 Rentals, Inc. to check my credit and employment history.

X _______________________________________ _______________________________________

APPLICANT SIGNATURE DATE

NOTES:

AGENCY DISCLOSURE:

IN VIRGINIA, REAL ESTATE LICENSEES WHO HAVE ENTERED INTO BROKERAGE RELATIONSHIP ARE:

1. REQUIRED BY LAW TO MAKE WRITTEN DISCLOSURE OF THOSE BROKERAGE RELATIONSHIPS TO THOSE THEY WORK WITH BUT DO NOT REPRESENT IN THE REAL ESTATE TRANSACTION.

2. MAKE WRITTEN DISCLOSURES AND OBTAIN TIMELY CONSENTS FROM THEIR CLIENTS IN ORDER TO ENTER INTO CERTAIN BROKERAGE RELATIONSHIPS.

THIS DISCLOSURE FORM IS PROVIDED TO COMPLY WITH THESE REQUIREMENTS.

AT B&B REALTY, OUR POLICY IS TO TREAT ALL PARTIES IN A HONEST WAY WITH THE HIGHEST RESPECT, REGARDLESS OF WHOSE INTEREST A LICENSEE REPRESENTS.

DISCLOSURE OF BROKERAGE RELATIONSHIP

THE UNDERSIGNED DO HEREBY ACKNOWLEDGE DISCLOSURE THAT B & B REALTY, THE LICENSE

BETTY SURBER REPRESENTS THE LANDLORD IN A REAL ESTATE TRANSACTION.

X ---------------------------------------------------------------------------- ----------------

(SIGNATURE) ( DATE )

SIGN AT THE X'S AND MAIL TO:

A-1 Rentals, Inc.

770 Wytheview Dr

Wytheville, VA 24382

Application must be filled out 100% and signed at each (X) or it will be rejected.

For more information call: 1-276-988-7431