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VIRGINIA ASSOCIATION OF REALTORS® APPLICATION FOR LEASE (This is a legally binding contract. If not understood, seek competent advice before signing.) The property will be shown and made available to all persons without regard to race, color, creed, religion, national origin, sex, familial status, handicap, or elderliness in compliance with all applicable federal and state and local fair housing laws and regulations. day of This Application for Lease (the "Application") is made as of the through and , by and between ("Applicant", whether one or more) and ("Landlord") ("Listing Broker" or "Agent," who represents Landlord), ("Leasing Broker," who does or does not X represent Applicant). Elite Real Estate Elite Real Estate Applicant hereby applies for a residential dwelling unit (the "Dwelling Unit") located at Virginia, in the City/County of , for occupancy commencing on at an initial monthly rent payment of ($ ). , , Dollars PLEASE FILL IN ALL INFORMATION COMPLETELY 1. Applicant: Date of Birth: SSN/ITIN: Tel # (H): Cell Phone #: Tel # (W): Email: Present Address: Years: Landlord: Street / P.O. Box Landlord's Tel #: City State Previous Address: Zip Years: Landlord: Street / P.O. Box Landlord's Tel #: City State Zip Presently Employed By: Position: How long? Salary $ (Wk., Mo., Yr.) Supervisor: Telephone: Formerly Employed By: How long? 2. Co-Applicant: Supervisor: SSN/ITIN: Tel # (H): Tel # (W): Date of Birth: Cell Phone #: Email: Present Address: Years: Landlord: Street / P.O. Box VAR FORM 300 REV. 11/08 PAGE 1 OF 5 Elite Real Estate 12000 Wyndham Lake DriveGlen Allen, VA 23059 Phone: (804) 237 - 6035 Fax: (804) 237 - 6055 Bruce Flight Produced with ZipForm™ by RE FormsNet, LLC 18070 Fifteen Mile Road, Fraser, Michigan 48026 BKF - General www.zipform.com Landlord's Tel #: City State Previous Address: Zip Years: Landlord: Street / P.O. Box Landlord's Tel #: City State Zip Co-Applicant Employed By: Position: How long? Salary $ Supervisor: Telephone: 3. Other Occupants: Name: Age: Relationship: Name: Age: Relationship: Name: Age: Relationship: 4. Number of Vehicles: 5. Pets: Kind: Type: Color: Other: How Many: 6. If you are presently in Armed Services, state: Applicant Branch: Rank: Rank: Outfit: Outfit: Telephone: Telephone: Co-Applicant Amount $ Name: ID TAG #: Co-Applicant Branch: 7. Other Income: Applicant Amount $ Weight: Per: Source Of: Per: Source Of: 8. Complete and specifically list any debts now outstanding (attach additional sheet if necessary). CREDITOR ADDRESS ACCOUNT NO. Information Not Needed - Credit Report will be used. Information Not Needed - Credit Report will be used. Information Not Needed - Credit Report will be used. Information Not Needed - Credit Report will be used. VAR FORM 300 REV. 11/08 MONTHLY PAYMENT $ $ $ $ PAGE 2 OF 5 Produced with ZipForm™ by RE FormsNet, LLC 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.zipform.com BKF - General CHECKING ACCOUNT NO. BANK ADDRESS SAVINGS ACCOUNT NO. BANK ADDRESS AUTOMOBILE: MAKE YR. MODEL FINANCED BY AND ADDRESS MO. PAYMENT LICENSE #: AUTOMOBILE: MAKE YR. MODEL FINANCED BY AND ADDRESS MO. PAYMENT LICENSE #: 9. CHECK IF YOU OWN: CAMPER MOTORCYCLE BOAT TRUCK TRAILER 10. In Case of Emergency Notify: Name Address Phone Relationship 11. APPLICATION FEE/THIRD PARTY COSTS/APPLICATION DEPOSIT: A non-refundable Application Fee in the amount of accompanies this Application. In addition, third party costs incurred by Landlord in the amount of 50.00 accompanies this Application. An Application Deposit of N/A accompanies this Application 0.00 and will become the Security Deposit upon commencement of the Lease Agreement. 12. OBLIGATION TO ENTER INTO LEASE AGREEMENT/ DAMAGES: Upon submission of this Application by Applicant, Agent reserves the right to remove the Dwelling Unit from the available rent list. If this Application is approved and Applicant fails to rent the Dwelling Unit, Landlord shall be entitled to retain that part of the Application Deposit equal to Landlord's actual damages and expenses as otherwise provided in the Virginia Residential Landlord Tenant Act ("VRLTA"). 13. DISCLOSURE OF BROKERAGE RELATIONSHIP: Landlord and Applicant confirm that in connection with the transaction contemplated by this Application, the Listing Broker and its salespersons represent Landlord, and the Leasing Broker and its salespersons represent Landlord X or Applicant . If Listing Broker is engaging in dual or designated agency, a separate consent agreement has been entered into by Listing Broker and Applicant. 14. RENTAL AND CREDIT HISTORY: (a) Reason for leaving current residence: (b) Has any Applicant ever been rejected for tenancy? Yes ; No . If yes, please explain: (c) Has any Applicant ever refused to pay rent when due, been a defendant in an unlawful detainer action or eviction, or otherwise been sued by a landlord for matters related to a tenancy? If so, please give details, and the status of any pending actions: (d) Has any Applicant ever filed for bankruptcy? Yes ; No . If so, please give dates of filing and status of case: (e) Please give the names and phone numbers of three references: Name: Phone Number: Name: Phone Number: Name: Phone Number: (f) Please provide the following information if the Lease Agreement will be guaranteed, in accordance with the Rental Selection Criteria of Listing Broker or Landlord. Name of Guarantor: SSN/ITIN: Address: Phone Number: Name of Guarantor: SSN/ITIN: Address: Phone Number: VAR FORM 300 REV. 11/08 Relationship: Date of Birth: Relationship: Date of Birth: PAGE 3 OF 5 Produced with ZipForm™ by RE FormsNet, LLC 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.zipform.com BKF - General 15. CRIMINAL HISTORY: Has any Applicant ever been convicted of, pleaded guilty to, or entered a plea of no contest to any felony, or to any misdemeanor involving a crime of moral turpitude in any jurisdiction? YES NO If the answer is yes, please give all details, including the specific offense(s), date(s), sentence(s) and jurisdiction(s) in which the offenses occurred, as well as any information on the status of any current probation. 16. APPLICANT INVESTIGATION: Applicant should exercise whatever due diligence Applicant 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.vsp.state.va.us/. 17. INFORMATION CORRECT: Applicant hereby certifies that the information contained in this Application is true and correct to the best of Applicant's knowledge and belief. Applicant hereby authorizes Listing Broker to conduct a credit check on Applicant and such background checks as determined appropriate by Listing Broker to verify information provided herein by Applicant for approval or rejection of this Application and agreed to pay for the third party costs identified in Paragraph 11 above. 18. OTHER PROVISIONS: We have read the terms and conditions of this Application. We understand this is a binding contract separate and apart from the Lease Agreement. SIGNATURE OF APPLICANT Date SIGNATURE OF APPLICANT Date SIGNATURE OF GUARANTOR Date SIGNATURE OF GUARANTOR Date LISTING BROKER TO VERIFY APPLICANT'S IDENTIFICATION TYPE OF IDENTIFICATION VAR FORM 300 REV. 11/08 PAGE 4 OF 5 Produced with ZipForm™ by RE FormsNet, LLC 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.zipform.com BKF - General The undersigned acknowledges receipt from Applicant of the sum of $ 0.00 payable to , which amount consists of an Application Fee in the amount of N/A $ 0.00 and an Application Deposit in the amount of $ 0.00 . Signature of Recipient N/A This Application for Lease is hereby ACCEPTED as of the day of Date Received , . Signature of Landlord or Listing Broker N/A Leasing Broker's Address 12000 Wyndham Lake Drive, Suite B, Glen Allen, VA Phone number: 804.237.6035 Cell phone or pager number: 804.873.0625 23059 Email: Bruce.Flight@FlightHomes.com Broker's Code: Elite Real Estate COPYRIGHT©2008 by the VIRGINIA ASSOCIATION OF REALTORS®. All rights reserved. This form may be used only by members in good standing with the VIRGINIA ASSOCIATION OF REALTORS®. The reproduction of this form, in whole or in part, or the use of the name "VIRGINIA ASSOCIATION OF REALTORS®", in connection with any other form, is prohibited without prior written consent from the VIRGINIA ASSOCIATION OF REALTORS®. VAR FORM 300 REV. 11/08 PAGE 5 OF 5 Produced with ZipForm™ by RE FormsNet, LLC 18070 Fifteen Mile Road, Fraser, Michigan 48026 www.zipform.com BKF - General