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Lease Application

To download a PDF version of this application, Click Here

Personal Information
First Name
Middle
Last
Date of Birth
Social Security No. or ITIN
Email
Cell Phone
Phone 2
Property Requested
(In order of preference)
1.   2.  
3.   4.  
When Needed?
Student Status
(Complete if applicable)
Educational Institution
Student ID No
What year Student?
Type of Student
Other Occupants
(Separate applications required for occupants over 18)
Name
Age
Relationship
Name
Age
Relationship
Name
Age
Relationship
Name
Age
Relationship
Name
Age
Relationship
Name
Age
Relationship
Residences
Present Address
How Long
Monthly Rent
Monthly Mortgage
Landlord/Mortgagor
Previous Address (If applicable)
How Long
Monthly Rent
Monthly Mortgage
Landlord/Mortgagor
Employment Information
Current Employer
Business Address
City
State
Zip
Position
Salary
How Long?
Phone
Supervisor
Previous Employer *
Business Address
City
State
Zip
Position
Salary
How Long?
Phone
Supervisor

* Required only if present employment is less than 18 months.

Other Income / Source of Funds Information
If other income / source of funds, please explain (Amount, Source, Etc.):
Vehicle Information
Driver's License No.
License State
Auto Make/Model/Year
Auto Color
Auto Tag Number
Tag State
Emergency Contact
Contact Name
Relationship
Phone 1
Phone 2
Street Address
City
State
Zip
Legal / Credit
Are there any outstanding judgments or collections against you? Yes  No
Are you currently in or contemplating bankruptcy? Yes  No
Have you declared bankruptcy in the past 5 years? Yes  No
Have you been evicted for non-payment of rent or lease violations in the past 5 years? Yes  No
If you answered yes to any question above, please explain:
How did you learn about our properties?
Friend / word of mouth cbsrentals.com Search Engine
Visited property BRAC.com Drive by / Curb appeal
UVA Offgrounds Website Cavalier Daily Other (explain below)
Equal Housing

Our properties will be shown and made available to all persons without regard to race, color, religion, national origin, sex, familial status, disability, source of funds, sexual orientation, gender identity, status as a veteran, or elderliness in compliance with all applicable federal, state and local housing laws and regulations.

Terms & Conditions
  1. Rental rates are subject to change without notice pending full lease execution.
  2. A non-refundable $35.00 application fee is charged to cover our expenses incurred in verifying the information Applicant provides on this application. Applicants filing this information electronically must submit the applicant's photo identification and pay the application fee by debit/credit card/check. The application fee can be submitted via phone during business hours at (434) 971-9922. Copy of photo identification and/or application fee may also be mailed to: CBS Rentals LLC, PO Box 1414, Charlottesville, VA 22902 or delivered to the rental office at 120 13th Street NW, Charlottesville, VA 22903. Applications received without fees and copies of photo identification are deemed incomplete and will not be processed until the application fee and photo identification are received. NOTICE: When you provide a check as payment, you authorize CBS Rentals LLC either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your check, and you will not receive your check back from your financial institution.
  3. I hereby give consent and authorize CBS Rentals LLC and its agents to make any and all inquiries necessary to obtain and verify information regarding my credit history, rental history, mortgage history, income/source of funds, student status and/or employment status for the purposes of processing this application. I also authorize my employer, landlord, creditors, and any other person or agency to furnish any information as requested by CBS Rentals LLC for the purposes of processing this application.
  4. I certify that I am above legal age and the above information is true and correct to the best of my knowledge. I understand that any lease agreement made on the basis of the above information may be terminated at any time at CBS Rentals LLC's option if this information is found to be false.
  5. A copy of the criteria used to determine eligibility to rent (Statement of Residential Rental Criteria) is available to Applicant upon request.
  6. I certify that I am not, and am not acting, directly or indirectly, for or on behalf of any person, group, entity, or nation named by any applicable law, executive order or government department or agency as a terrorist, "Specially Designated National and Blocked Person", or other banned, blocked or prohibited person, entity, nation, or transaction pursuant to any law, order, rule, or regulation that is enforced or administered by the Office of Foreign Assets Control or any other federal or state government department or agency.
  7. In lieu of an original signature to this agreement, landlord will accept a valid and legitimate electronic and/or facsimile signature of the Applicant. In doing so, Applicant hereby acknowledges his/her endorsement and acceptance of this agreement and waives any challenge to the validity of this agreement based on Applicant's endorsement by electronic and/or facsimile signature.
Student ID

Upload a picture of your Student ID here:

Many phones or tablets will give an option to take a photo after pressing the button above. JPG, JPEG, GIF, or PNG images only.

Driver's License

Upload a picture of your Driver's License here:

Many phones or tablets will give an option to take a photo after pressing the button above. JPG, JPEG, GIF, or PNG images only.

By checking this box, Applicant agrees to the terms and conditions contained in this application.

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