Siebert Realty - Virginia Beach VA

601 Sandbridge Road
Virginia Beach VA 23456
(757) 426-6200 Ext 541
Toll Free (877) 422-2200 Ext 541
FAX (757) 721-5300

Winter Monthly
Rental Application

Rental Properties you are applying for (in order of preference)
1st Choice:		Rent:$
2nd Choice:		Rent:$
3rd Choice:		Rent:$

Lease Dates Preferred: (Enter dates as mm/dd/yyyy)
From:
To :

Full Name :
Soc.Sec.#:
Work # :
Home # :

Spouse's Name:
Spouse's SS#:
Spouse's Work#:

Present Address:
How long at Present Address: Monthly Rent: $

2.
Present Landlord:
Address:    Phone #:
Notes:

3.
Number of Persons to occupy property: (Give names, ages, relationship)
    a.     b.
    c.     d.

4.
Pets: How many?
What type of pet(s)? Please be specific:

5.
Name of Employer:     Employer's Phone#:
How long?:     Position Held:
Annual Income:$    Other Income:$

6.
Spouse's Employer:     Employer's Phone#:
How long?:     Position Held:
Annual Income:$    Other Income:$

7.
Automobiles: Make:   Year:   License#/State:
                     Make:   Year:   License#/State:

8.
Person to notify in case of emergency: Relationship:
Address:
Phone#:

Your E-Mail address: (For response via E-Mail)

A. This application shall not be construed as a lease agreement therefore.
B. This application is made subject to Owner's approval and may be dissapproved without designating cause.
C. Its is understood if this application is approved, the deposit made will be held as security for the performance of all terms and conditions of the Lease Agreement by the applicant. However, if this application is approved by the Owner and the applicant does not enter into a Lease Agreement, the deposit made shall not be refunded. In the event this application is not approved, the deposit will be returned to the applicant and both parties shall have no further liability to each other.
D. All questions must be answered in order for application to be considered.
E. Applicant(s) authorize the REALTOR to verify the foregoing information and to make a credit and reference inquiries deemed necessary by them, and applicant(s) also authorize the release of information contained on this application or sought by such inquiries.
F. An APPLICATON FEE OF $20.00 (non-refundable) must be paid by check or money order and mailed to:
Kat Donald, Siebert Realty, 601 Sandbridge Road, Virginia Beach VA 23456 before final approval of application.

Note: This rental application will be submitted from an unsecured site. If you do not wish to submit this application you can print out a completed copy and FAX to (757)-721-5300 Attn: Kat Donald. Submission of this application is authorization for item "E." referenced above in lieu of signature.

Siebert Realty - Established 1962 - 601 Sandbridge Road Virginia Beach, VA 23456
Toll Free (877)422-2200 - (757)426-6200