RENT/LEASE OPTION APPLICATION

EACH RESIDENT OVER 18 YEARS OF AGE MUST COMPLETE AN APPLICATION.

First Name Maiden Name/Alias Home Phone Driver License No:

Present Address incl City, State, Zip
If renting, Apartment name/location

M.I. Sex Work Phone State: Exp Date

Last Name SSN: Cell Phone Email: DOB:

Current Rent $ How Long?

How long? Landlord Name:

Employer Employer Address

Emergency Contact

Position

Supervisor $

GROSS MONTHLY INCOME BEFORE DEDUCTIONS

Phone #

Relationship

Emergency Contact Address Agent You're working with?

Address Applying For
Move in Date Option Amt

$ Bankruptcy?

Rent Amt

$ Type?_________

How is Your Credit? Excellent?

Good?

Fair?

Poor?

By my signature, I declare that this application is complete, true and correct to the best of my knowledge, understanding and belief. I herewith give my permission for anyone contacted in this capacity to release the credit or personal information of the undersigned applicant to Fresh Start Realty, Fresh Start Property Solutions and/or Fresh Start Group, hereinafter Fresh Start, and thei r authorized agents and assigns, at any time, for the purposes of entering into and continuing to offer or collect on any agreement and/or credit extended, including credit reporting bureaus. I further authorize Fresh Start or their Authorized Agents or assigns to verify the application information including but not limited to obtaining criminal records, contacting creditors, present or former landlords, employers and personal references, whether listed or not, at the time of the application and at any time in the future, with regard to any agreement entered into with Management. Any false information will constitute grounds for rejection of this application, or Management may at any time immediately terminate any agreement entered into in reliance upon misinformation given on the application. By providing the home phone numbers and email addresses above, I/we hereby authorize Fresh Start to contact me/us at my/our home phone numbers or email addresses. The nonrefundable fee per mandatory adult screening is $35, and is payable to cashier check, money order, cash, Visa, Master Card, American Express or Discover. If paid by credit card, charge that will appear on your credit card will be "Fresh Start Realty." By providing credit card information and signing below, I/We hereby authorize Fresh Start to charge my credit card accordingly, and I unde rstand and acknowledge that this is a NONREFUNDABLE FEE. If paid by credit card, you will receive a receipt by email if you have provid ed an email

Visa, Amex, Discover, Mastercard? Card #

Exp Date:

CVV:__________
3 Digit Code on Back

Signature:

Date

NOTICE: Our Lease Option Homes are sold ON A FIRST COME, FIRST SERVED BASIS. If you delay in applying, YOU COULD LOSE THIS HOME! 1. With Payment by Credit Card Send BY FAX to 804-212-1158; or 2. With Payment by Check or Money Order made payable to FRESH START GROUP BY US MAIL or DROP OFF AT OUR OFFICE: Fresh Start Realty, 11207 Nuckols Rd, Ste F, Glen Allen, VA 23059