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Rental Application Online Form

Application Fee of $10 per Person

Please, either fill out form and press "submit form" or print out form and mail or fax.

Property Area:

Roanoke Vinton

Type and Size of Apartment Wanted:

Desired Date of Occupancy:

(mm/dd/yyyy)

How did you hear about our property?

Personal Information

Applicant's Full Name:

Co- Applicant's Full Name:

Date of Birth:

(mm/dd/yyyy)

Co-Applicant's Date of Birth:

(mm/dd/yyyy)

Social Security No.:

Co- Applicant's Social Security No.:

Email Address:

Other Residents:

Do you own Furniture?:

Do you own Pets?:

Residence History

Present Address:

Length of Time at Present Address:

Present Telephone:

Present Landlord or Mortgage Holder and Telephone:

Amount of Rent $:

Reason for Moving:

Previous Address:

Length of Time at Previous Address:

Previous Landlord or Mortgage Holder and Telephone:

Amount of Rent:

Reason for Moving:

Employment Information

Your Employer:
• Company Name
• Address
• Telephone

Position Held (and Length of Employment):

Supervisor's Name:

Hourly Wage or Monthly Income

CO-Resident's Employer:
• Company Name
• Address
• Telephone

Position Held (and Length of Employment):

Supervisor's Name:

Hourly Wage or Monthly Income

Total Gross Monthly Income for All Applicants

Banking and Credit Information

Banking - Name and Branch:

Checking Account Number:

Savings Account Number:

Credit Reference - Name and Address:

Credit Reference - Account Number:

Credit Reference - Name and Address:

Credit Reference - Account Number:

Other Information

TOTAL NUMBER OF VEHICLES (Including Company Vehicles)

Make/Model

Year

Color

Tag No./State

Make/Model

Year

Color

Tag No./State

Other Car, Motorcycle, etc

If there are other sources of income you would like us to consider. please list income source and person(Banker Employer, etc.) Who we could contact for conformation. You do NOT have to reveal alimony, child support or spouse's annual income unless you want us to consider it in this application.

Amount $

Per

Source

Telephone

Amount $

Per

Source

Telephone

Comments

HAVE YOU OR CO-APPLICANT EVER:

Been sued for non-payment of rent? Yes No

Been evicted or asked to move out? Yes No

Broken a Rental Agreement or Least Yes No

Been sued for damage to rental property? Yes No

Declared Bankruptcy Yes No

In Case of Emergency, Notify

Relationship

Address

Home Phone

Work Phone

How did you hear about our property?

Security Code

I have read and I accept the following terms:

By filling in this electronic application, you are giving RGM Properties permission to verify your information, and also perform a credit inquiry with the Equifax Reporting System.
This application is one of three parts. Part 2 will require a photo ID and Part 3 will require answering a criminal background questionnaire.
I understand that the application fee is $10 per applicant and the fee must be submitted to the following address before the application will be processed.
You can submit this form below, or print it out and send it to:

     RGM Properties
     P.O. Box 18208
     Roanoke, VA 24014