$25.00 Application Fee Per Person 18 Yrs. Or Older

$25.00 APPLICATION FEE PER PERSON 18 YRS. OR OLDER NO PERSONAL CHECKS: ONLY MONEY ORDER, CASHIERS CHECK, OR CASH APPLICATION FEE IS NON-REFUNDABLE

MAIN STREET PROPERTIES, INC. 2111 WEST MAIN STREET RICHMOND, VIRGINIA 23220 (804) 355-5775 / FAX: (804) 353-5514

RENTAL APPLICATION

APPLICANT'S INFO: (All applicants must have a proper photo ID and social security number)

______/______/______Applicants name (First, Middle, Last) Social Security Number Home Phone Number

______/______/______Spouse or Co-signer (First, Middle, Last) Social Security Number Home Phone Number

______/______/______/______Present Address Apt. # City State Zip Code

______/______/______/______Previous Address or co-signers present address Apt. # City State Zip Code

RENTAL INFO:

______/______$______/______Present Landlords name Landlords Phone Number Rental Rate How long?

______/______$______/______Previous Landlord’s or co-signers present Landlord’s Phone Number Rental Rate How long?

EMPLOYMENT INFO:

______/______/______/______$______Applicants Employer Phone # Date of Employment Position Salary (per month)

______/______/______/______$______Spouses or co-signers Employer Phone # Date of Employment Position Salary (per month)

ADDITIONAL INCOME: If you receive Social Security (Attach a copy of your income statement), Child Support (Attach a copy of your Court order), or if you are self employed (Attach a copy of your most recent tax forms).

MISCELLANEOUS: Have you ever (circle one): a.) been evicted? Yes No b.) failed to timely pay rent? Yes No c.) filed for bankruptcy? Yes No, If yes when and has it been discharged? d.) been foreclosed on, or in the process of Yes No, If yes how long ago? Please explain below if you circled "yes" for any item(s). Any false information given is reason for denial!

LIST OF OCCUPANTS: Name: ______Age: ______Name: ______Age: ______Name: ______Age: ______Name: ______Age: ______

NEAREST RELATIVE: ______/______/______Name Street address, city, state & zip code Phone Number

PLEASE READ THE FOLLOWING:

I /We understand that Main Street Properties, Inc. is an Agent of the Landlord and is a paid representative of the Landlord. I /We acknowledge that this written notice was received before a Lease Agreement was signed. I /We represent that the above information furnished is true and correct. I /We authorize you to conduct an employment, residential history, income verification, credit history, and criminal background investigation.

______Applicant Signature Date

______Spouse Signature or Consigner Signature Date

======THE FOLLOWING IS FOR OFFICE USE ONLY!!!!

Unit applying for:______Date needed:______Pets? ______