SHIELDS BROTHERS, INC.
650 SPRING STREET
DANVILLE, VIRGINIA 24540

 

PH: (434)793-1833     FAX # (434)793-1191

RENTAL REFERENCE REQUEST

 

TO: _________________________________                        FROM:___________________________________

 

         _______________________________________                                             __________________________________________

         _______________________________________                                             __________________________________________

         _______________________________________                                             __________________________________________

RE: ____________________________________________________________________________________________(TENANT)

RENTAL OF: ______________________________________________________________________________
The Tenant (s) named above have applied to us for a rental unit and authorized disclosure of information pursuant to
Virginia Code 55-248 9.1 We understand you may have rented to them in the past.  Please furnish the information requested and FAX or mail your reply to us.  Thank you for your help.

TENANTS AUTHORIZATION PURSUANT TO VIRGINIA CODE 55-248 9.1

I authorize the free and complete release of all information about my tenancy at ANY rental unit, and agree to hold
Harmless anyone who so responds in good faith.  A copy or fax of this authorization shall be accepted as if an original.

Date: _________________________            Tenant Signature: ______________________________________________

 

 

 

 

  

 

 

 


1. When did the Tenant rent from you?  From _________________________ TO ________________________________

2. Most recent monthly rent was ____________________ Were Utilities included? ‘ Yes    ‘ No

3. Rent was received more than 5 days late _______ times (please indicate 0 or amount, ** explain if over “0”)

4. Did tenant damage the rental unit or common area of the property? ‘ ** Yes    ‘ No

5. Tenant was sent _________ notices of rental or lease violations (please indicate 0 or amount, ** explain if over “0”)

6. Did/will Tenant receives the full security deposit, refund? ‘ Yes      ‘ ** No

7. Are you owed money by Tenant? ‘ ** Yes       ‘  No

8. Was there any Court action involving Tenant? ‘  ** Yes       ‘  No

9. Would you lease to Tenant again? ‘  Yes       ‘ ** No

10. Are you related to Tenant by blood or marriage? ‘ ** Yes    ‘ No

11. **Comments (Please explains *starred* answer use additional paper if needed) _______________________________

To be dated and             Date _____________________ Signed ____________________________________________
Signed by person
Completing form           Print Name and Title: _________________________________________________________

  

 


                                                                                                                                    

PROPERTY OFFERED SUBJECT TO CONFIRMATION. COMPLETE TERMS AND CONDITIONS OF SALE TO BE ANNOUNCED PRIOR TO THE START OF THE AUCTION SALE. THE AUCTION COMPANY SHALL NOT BE LIABLE FOR ERRORS OR OMISSIONS IN ADVERTISING. THE AUCTION COMPANY IS REPRESENTING THE SELLER IN THIS TRANSACTION, UPON CONFIRMATION THE AUCTION COMPANY BECOMES A DUEL AGENT REPRESENTING BOTH THE SELLER AND THE PURCHASER. THE PROSPECTIVE PURCHASER WILL BE GIVEN THE OPPORTUNITY TO PERFORM A LEAD BASED INSPECTION PRIOR TO SALE IF REQUESTED.  WAIVER MUST BE SIGNED.