Uva'S Roommate Agreement Service Form Page 5

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SMOKING
q Smoking q shall OR q shall not be allowed on the premises, either by roommates or their guests OR 

q Smoking shall be limited to the following areas ______________________________________________________________
PETS
Each pet owner shall be responsible for all damages cause by his/her pet. This includes damage to furniture, carpeting, blinds,
doors, lawn, and garden. The pet owner shall reimburse monies withheld from the security deposit, or paid by roommates, for
such damage, including costs incurred by the landlord for caring for abandoned pet(s).
ADDITIONAL items for consideration are below. Attach all agreements regarding these items and other issues:
q Security
q Phone Messages
q Mail
q Parties/Entertaining
q Other: specify
SIGNATURES OF ROOMMATES
______________________________________________ ______________________________________________
Signature
Date
Signature
Date
______________________________________________ ______________________________________________
Signature
Date
Signature
Date
______________________________________________ ______________________________________________
Signature
Date
Signature
Date
______________________________________________ ______________________________________________
Signature
Date
Signature
Date
Original copy of this agreement will be maintained by _____________________ and kept in ______________________.
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