Apartment Rental Application Form - Governor'S Pointe Apartments
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Apartment Assigned: ______________________________ Move-In Date: ____________________ Key Tag __________ Pro-Rated Rent $______________
Monthly Rent Amount: $_________________ Sec. Deposit Pd.: $______________ Lease Expiration:____________________ Parking #1 _______________
Processed By: ____________________
Approved by(Manager Only)/Date: ___________________/________________
Parking #2 _______________
APARTMENT RENTAL APPLICATION
Governor’s Pointe Apartments
412 Nicholas Court
Chesapeake, Virginia 23320
Toll Free Telephone: 1-877-246-7026
Governor’s Pointe Apartments does not discriminate against any prospective resident or employee because of their race, creed, age, religion, sex,
familial status, or disability. TO PROCESS APPLICATION, ALL LINES MUST BE COMPLETED/ NO WHITE OUT TO BE USED
Any misrepresented, misleading, incorrect or untrue statement discovered at any time will result in application rejection or lease termination.
Application Fee: $32 per Married Couple or per Each Single Person
Security Deposit:
Is based on credit worthiness/not to exceed the equivalent of two months rent but not less than $300
Apartment Desired (Circle): 1 Bedroom
2 Bedroom
Floor Level_________ Date Desired: ______________________________________
First Name ___________________ Middle Name _______________________ Last Name__________________________, _______
(Jr. Sr, etc.)
S.S.# ________-________-________ Date of Birth_______/_______/_______ Marital Status: _____________________________
Present Address ____________________________________________________________________________________________
City, State, and Zip ______________________________________________ E-mail Address ______________________________
Automobile Make ___________ Model ______________ Color ____________ Vehicle Tag Number and State _________________
Home Phone_________________________ Work Phone______________________ Cell Phone_____________________________
Own or Rent? __________. Current Monthly Rent: $____________________ Rental Agent Phone No. ______________________
If renting, Management Company/Apartment Complex ______________________________________________________________
Previous Address ______________________________________________________________ Years at Address _______________
Name of Rental Agent ________________________________________________ Rental Agent Phone No. ____________________
List all States lived in since age of 18 _____________________________________________________________________________
Place of Employment _________________________________________________________________________________________
Employment Address _______________________________________________________________________________________
City, State, and Zip _________________________________________________________________________________________
Title or Pay Grade _________________________________________________. Length of Employment _______________Years.
Gross Monthly Income $_______________________________ (Income before taxes and other deductions)
Supervisor __________________________________________________ Supervisor Phone _______________________________
Do you have more than one employer? ____ Yes ____ No. If yes provide information for all employers below.
Place of Employment:________________________________________________________________________________________
Employment Address ________________________________________________________________________________________
City, State, and Zip _________________________________________________ Title or Pay Grade ________________________.
Length of Employment ______Years. Gross Monthly Income $____________________ (Income before taxes and other deductions)
Supervisor __________________________________________________ Supervisor Phone _______________________________
If unemployed, do you anticipate becoming employed within the next twelve months? No ___ Yes____
Emergency Contact (Nearest Relative):
Name _________________________________________________________________________ Phone ____________________
Address ____________________________________________________________________________________________________
Monthly Payments and Balances for the Following:
FOR ALL APPLICANTS:
Obligation Type
Monthly Payment
Balance
Name
Acct. No.
Alimony
$___________
$__________
________________________________
____________________
Child Support
$___________
$__________
________________________________
____________________
Household Eligibility
Other Sources of Income or Anticipated Income from Assets:
Income Source
Monthly Income
Book/Face Value or Balance
Stock/Bond Dividends
$______________
$___________________
Interest Income (All Sources)
$______________
$___________________
Pension _______________
$______________
$___________________
Checking Acct ___________________ Yes ____ No ____
Acct Number _____________________ Balance $___________________
Savings Acct ____________________ Yes ____ No ____
Acct Number _____________________ Balance $___________________
Social Security and/or SSI
$______________
Alimony
$______________
Child Support
$______________
AFDC/Government Assistance
$______________
Unemployment Compensation
$______________
Total Cash Assets
$______________
List value of all Assets, including Stocks, Bonds, Trusts, Pensions Contributions, IRA’s, Keogh Accounts and Certificates of Deposits:
$____________. Did you have any assets in the last 2 years not listed above? No ____ Yes ____. If yes, did you dispose of the assets for less
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PMC Form 3 (July 2013)
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