Lloyd’s Real Estate

Lloyd’s Real Estate
Rental Application
*Each Adult over the age of 18 who lives in the home must fill out this application*
Applicant Information
Which rental are you Inquiring about?*
Name*

First NameLast Name
Date of birth:*

MonthDayYear
Date
Phone*
SSN
Landlords Name:*
Phone Number:*
Current Address*
Any late rents?*
Rent or Own*

RentOwn
Monthly payment or rent:*
How Long?*
Previous address: Please include zip code!*
Ever been evicted?*
Ever Filed for Bankruptcy?
Employment Information (will require documentation upon acceptance)
Current Employer*
Employer Address*
How long?*
Phone*
City*
State*
Zip Code*
Position*
Hourly or Salary*

HourlySalary
Annual Income*
Emergency Contact
Name of a person not residing with you:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:
Relationship:
Co-Applicant Information
Name:
Date of Birth
SSN:
Phone
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Own or Rent

OwnRent
Monthly Rent
How Long?
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Ever been Evicted?
Ever Filed for Bankruptcy?
Email:
example@example.com
Co-applicant Employment Information
Current employer:
Employer address:
How long?
Phone Number

Area CodePhone Number
Fax:
State:
ZIP Code:
Position:
Annual income:
References not living with you

I authorize the verification of the information provided on this form as to my credit and employment. I have received a copy of this application.
Reference not living with you (4 Minimum) Name, Address, and Phone Number*
Do you smoke?*

YesNo
*If your application is accepted there is a $100 administrative charge per adult in addition to the security deposit and monthly rental*
Signature of applicant:

Clear
Date:

MonthDayYear
Date
Signature of co applicant:

Clear
Date

MonthDayYear
Date
Credit History: (Please list all bills and payments per month you make
1.
2.
3.
4.
5.
Make Model Color Year. License Plates
Year.
Make and Model
License Plate
Year
Make and Model
License Plate
Year
Make and Model
License Plate
Any Animals?
Names and ages of those residing with you:*
Have you been convicted of a felony or any criminal charges that I should be aware of?*
Please list a reason you believe you would make a good tenant for this property? *
Do you have renters insurance?*

YesNo
How did you hear about Lloyd’s Real Estate?*
*If your application is accepted there is a $100 administrative charge per adult in addition to the security deposit and monthly rental*

This property will be shown and made available to all persons without regards to race, religion, color, creed, national origin, sex, familiar status, handicap or elderliness in compliance with all applicable federal and state as well as local fair house laws and regulations.

If you do not understand this application please seek legal advise. Failure to fill out the entire application in full will result in the application not being accepted and therefore, agent will move on to next applicant. Applications will only be kept on file for 60 days. After 60 days they are shredded.

Lloyds Real Estate is hired by the owners of said properties and in connection with these transactions represents the owners.

Applicant should exercise whatever due diligence deems necessary with respect to information on any sexual offenders registered under Chapter 23 (sec 19.2-387 et seq) of Title 19. Such information may be obtained by contacting your local police department or the Department of

State Police, Central Records Exchange at 804-674-2000 or www.state.va.us/vsp/vsp.html
RETURN APPLICATIONS VIA:
FAX: 540-967-0112
PHYSICAL ADDRESS: 105 East Main Street, Louisa, VA 23093
If you are accepted for this property, we require current paycheck stubs with year to date. Copies of Drivers License and other items upon request.
Should be Empty:

Lloyd’s Real Estate

Rental Application

Applicant Information

Emergency Contact

Co-Applicant Information

Co-applicant Employment Information

*If your application is accepted there is a $100 administrative charge per adult in addition to the security deposit and monthly rental*

RETURN APPLICATIONS VIA:

FAX: 540-967-0112

PHYSICAL ADDRESS: 105 East Main Street, Louisa, VA 23093

If your application is accepted there is a $100 administrative charge per adult in addition to the security deposit and monthly rental