Barracks West Apartments

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Barracks West Apartments 2639 Barracks Road Charlottesville, VA 22901 Phone: 434-971-5770 Fax: 434-971-5859 eMail: barrackswest@comcast.net			Office Hours: Monday-Friday 8:30 AM - 5:30 PM Saturday 10:00 AM - 5:00 PM Sunday Closed
Online Application for Residency
Required information is marked with an asterisk (*). Social Security Numbers are required to process this application. If you don't wish to submit Social Security Numbers by email, please enter "call" in those spaces. We will telephone you to obtain the Social Security Numbers.

Applicant Information
First Name: Last Name:
Social Security Number*:			Date of Birth* (mm/dd/yyyy):
eMail Address:
Current Address
Present Address*:
City*:		State*:		Zip*:
Phone* (###-###-####):	How long have you lived at this address*:
Previous Address
Previous Address*:
City*:		State*:		Zip*:
Marital Status
Marital Status: Single Married Divorced Widowed Separated
Are you paying Child Support or Alimony: None Child Support Alimony Both
Employment Infomation
Employer*:			Occupation*:
Employer Address*:
City*:		State*:		Zip*:
Phone* (###-###-####):	How long have you worked for this employer*:
Monthly Income*:
Additional Applicant Infomation
First Name: Last:
Social Security Number:			Date of Birth (mm/dd/yyyy):
Employer:			Occupation:
Employer Address:
City:		State:		Zip:
Work Phone (###-###-####): Monthly Income:
How long with this employer:
Other Occupants
List name, age and relationship of all persons to be occupying the premises (including children, relatives, and other co-residents.)
Name: Age:			Relationship:
Name: Age:			Relationship:
Name: Age:			Relationship:
Name: Age:			Relationship:
Vehicle Information
List all vehicles to be parked on the premises by applicant, spouse, or children (including: cars,trucks, motorcycles, trailers, and boats.)
Type: Year: Make: License: State:
Type: Year: Make: License: State:
Type: Year: Make: License: State:
Type: Year: Make: License: State:
Pets
Will you or the other occupants have a pet: None Dog Cat
Breed:	Size:		Weight: Age:
Bank Information
Name of your bank: City:				State*:
Other Information
Why are you leaving your present address:
Have you rented before:		Most recent rental:
How long:	Have you or your spouse ever been evicted:
Have you ever been convicted of a felony:
Emergency Contact
In case of an Emergency, notify:
Name:		Address:
City:		State:		Zip:
Relationship:

The parties confirm that in connection with any transaction, Barracks West Apartments and its agents have acted on behalf of Lessor. Applicant(s) represent all of the above statements are true and complete. Applicant(s) authorizes Lessor to verify the foregoing information and to make credit and reference inquires deemed necessary, and Applicant(s) also authorize the release of information contained on this application or sought by such inquiries. In making this application, it is understood than an investigative consumer report may be prepared whereby information is obtained through interviews with neighbors, friends, and others with whom Applicant(s) is/are acquainted. This inquiry includes information as to the character, general reputation, personal characteristics, and mode of living of Applicant(s). Applicant(s) has/have the right to make written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigation. Applicant(s) agree(s) to lease the foregoing premises and agree to execute the standard form of Lease utilized by the owner of such premises in the leasing for similar premises, a copy of which has been exhibited to Applicant(s). A security deposit equal to $300 is required. The rent for the first month will be paid and such lease shall be executed before occupancy. The security deposit will be refunded if the application is not accepted. All checks for security deposit must be made payable to Barracks West Apartments. By law, all returned security deposits will be returned to the person(s) that submitted the security deposit. There is a $30/$40 non-refundable application fee, per applicant, due upon receipt of this application. Payment for this application cannot be included in the security deposit. A check for application fee can be made payable to Barracks West Apartments This application is preliminary only and does not oblige Owner to execute a Lease or deliver possession of the proposed premises.
Digital Signature
I/We have read and agree to all provisions as stated. I/We Warrant All Information Listed Above is True And Do Hereby Authorize the Release Of This Information To Management Of Barracks West Apartments For The Purposes of Verification.
Applicant:			Date (mm/dd/yyyy):
Applicant:			Date (mm/dd/yyyy):
Applicant:			Date (mm/dd/yyyy):
Applicant:			Date (mm/dd/yyyy):
(Typing names in spaces above constitutes a signature by applicant and/or spouse.)

Barracks West Apartments
2639 Barracks Road
Charlottesville, VA 22901
(434) 971-5770 Fax: (434) 971-5859
eMail: barrackswest@comcast.net