Carriage Hill - Application

825 Beverly Dr., Charlottesville, Va 22911 Tel: 434-971-8439 Fax: 434-971-4742

To reserve an apartment at Carriage Hill Apartments, a separate Rental Application for everyone over the age of 18 and $35 application fee (single) / $50 application fee (married) must be provided. You can use the online form below to apply.

Click here to print out a PDF version of this form to mail or fax to us at 434-971-4742.

NAME:	First	Middle (complete)	Last	SSN	Date of Birth (mm/dd/yyyy)
Your Name

YOUR APARTMENT NEEDS:
Date Needed	Number of Bedrooms	Marketing Source

PRESENT RESIDENCE:
Address
City-State-Zip
Home Phone
Cell Phone
Email
Landlord/Mortgage Co. Reference
Landlord/Mortgage Co. Phone
Dates - From	To Monthly Rent/Mortgage $

PREVIOUS RESIDENCE: (if less than one year at current address)
Address
City-State-Zip
Landlord/Mortgage Co. Reference
Landlord/Mortgage Co. Phone
Dates - From	To Monthly Rent/Mortgage $

EMPLOYMENT / GRADUATE SCHOOL INFO IN CHARLOTTESVILLE:
Employed by	Date Started:
Position
Address	Phone
Supervisor	Salary $

PREVIOUS EMPLOYMENT / SCHOOL INFO:
Employed by	Dates - Start: End:
Position
Address	Phone
Supervisor	Salary $

ADDITIONAL INCOME:
Amount $	Source

BANKING REFERENCES:
Current Banking Institution
Branch Location (City, State)

OCCUPANT INFORMATION: (List all other authorized occupants)
Name:	Relationship: DOB:
Name:	Relationship: DOB:
Name:	Relationship: DOB:

Convictions:	Excluding minor traffic violations; have any of the Occupants ever been charged or convicted of a misdemeanor, felony or other criminal activity ? Yes No If Yes, please explain (with dates):

PETS:
Do you have a Pet? Yes No
If "Yes", please provide the information below:
How Many?	(2 maximum)
Type of Pet(s)
Dog Breed(s)	Weight at maturity Lbs. (80 lbs. Maximum)
Pet Fees / Rent / Restrictions:	Call for current rates, breed restrictions, and pet policies.

IN CASE OF EMERGENCY:
In the event of an emergency or death, name of contact person who will not be residing with you in the apartment.
Contact	Relationship
Address	Phone

OPTIONAL DEMOGRAPHIC INFORMATION:
This optional information is requested to meet federal and state reporting requirements and to help us understand and serve its residents. It will not be used as a basis for application approval or in a discriminating manner. You will not be subject to adverse treatment if you do not provide this information.
Select one or more of the following racial categories to describe yourself:	American Indian or Alaskan Native Asian Black or African American Hispanic or Latino Native Hawaiian or Pacific Islander White

IMPORTANT TO APPLICANT:

There is a $35.00 (single) or $50.00 (married), non-refundable application fee, per Applicant, due upon receipt of this application. Payment for this application cannot be included in the security deposit. A check for the application fee can be made payable to Carriage Hill Apartments or applicants may use Paylease and charge the application fee(s) or send in an ACH.

Market rent may vary and is not guaranteed beyond the date of this application.

The undersigned understands that a non-refundable application fee is hereby accepted. This fee is accepted to reimburse the Landlord for the cost of verifying the information provided above. Landlord will make inquiries to obtain information regarding Applicant's income, rental history, criminal background and credit worthiness. Landlord will provide Applicant, upon request, the written rental criteria used to determine whether this application is accepted or rejected.

Applicant(s) grant Carriage Hill Apartments the right to conduct a criminal background check for any convictions. Management reserves the right to reject the application if undersigned has been convicted of the illegal manufacture or distribution of a controlled substance as defined by federal law; or on the grounds that Applicant poses a clear and present threat of substantial harm to others or the dwelling itself; or on the grounds that Applicant, based upon a prior record of criminal convictions involving harm to persons or property, would constitute a clear and present threat to the health or safety of other individuals.

All Applicants 18 years of age and older who will reside in the leased apartment must complete an application and be approved individually. Applicant certifies that he/she is above the legal age of majority and that the above information contained in this application is true and correct. Applicant authorizes owner or agent to make inquiries and gather information in order to approve or reject the application. Applicant understands that any lease contract entered into by the Landlord may be terminated at any time by the Landlord if representations made in this application are discovered to be false.

Applicant authorizes landlord to respond to authorized requests, either orally or in writing. Applicant authorizes landlord to verify any and all information contained in this application, and to inquire into credit, character, general reputation, personal characteristics, and mode of living, and release all concerned from any liability in connection with any information they give.

This application is preliminary only and does not oblige Owner to execute a Lease or deliver possession of the proposed premises.

DIGITAL SIGNATURE:
I have read and agree to all provisions as stated. I Warrant All Information Listed Above is True And Do Hereby Authorize the Release Of This Information To Management Of Carriage Hill Apartments For The Purposes of Verification.
Applicant	Date (mm/dd/yy)
(Typing name in space above constitutes a signature by applicant.)
WILL YOU NEED A VISUAL RESPONSE SMOKE DETECTOR IN YOUR APARTMENT? Yes No (This is an optional question, however, by law we are required to provide visual response smoke detectors to all hearing impaired residents. Your response will in no way affect your application for rental.)

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