RENTAL APPLICATION

Rental Application Tim & Rachel Boddy, 435 Tanglewood Loop, New Creek, WV 26743

304-813-2959 304-813-5257 e-mail: trboddy@frontier.com

Instructions: A separate application must be filled out by each applicant (even if married). Completely fill out each blank and sign where indicated

PERSONAL

APPLICANT_____________________________________________________________________

MARITAL STATUS___Single___Married since (date)_______Divorced since (date)_______Former Spouse_____________

BIRTH DATE:__________SS#___________________DRIVERS LICENSE State issued by________#__________________

ADDRESSES

Present City/

Address______________________________________ State/Zip_________________________________Since__________

Rent/

Month__________ Present Phone__________________________ Cell#_______________________________

Present Landlord______________________Address__________________________________ Phone___________________

Is present rent up to date __Yes __No Have you given notice __Yes __No Have you been asked to leave __Yes __No

City/

Previous Address______________________ State/Zip______________________________________ Since___________

Rent/ Previous City/

Month______Landlord__________________Address___________________State/Zip________________Phone__________

Was rent up to date __Yes __No Had you given notice __Yes __No Had you been asked to leave? __Yes __No

Next Previous City/

Address__________________________ State/Zip____________________________________________ Since___________

Rent/ Previous City/

Month______Landlord__________________Address___________________State/Zip________________Phone__________

Was rent up to date __Yes __No Had you given notice __Yes __No Had you been asked to leave? __Yes __No__

OCCUPANTS

Number to occupy__________

Name Relationship Birth Date

No pets allowed

CARS

Make/ State____________________ Lien

Model/color #1_________________________________License Plate #1_____________Holder #1_____________________

Make State____________________ Lien

Model/color #2_________________________________License Plate #2_____________Holder #2_____________________

EMPLOYMENT

EMPLOYER_______________________Since_______EMPLOYER_______________________________Since__________

Address_______________________________________ Address________________________________________________

Job title_______________________________________ Job title________________________________________________

Wrk Wrk.

Supervisor____________Hrs.____ Phone____________ Supervisor_________________Hrs._______ Phone:____________

INCOME

Current Income $_______________Weekly/Biweekly/Monthly/Yearly Source____________________________________

Bank/Credit Union______________ Acct.#_______________ Bank/Credit Union____________________ Acct.#_________

REFERENCE

Non-Relative

Relative______________________Relation__________ Reference______________________________Phone____________

Address______________________Phone____________Address_________________________________________________

_________________________________________ _________________________________________________

Non Relative Emergency

Reference____________________Phone___________ Contact________________________________Phone____________

CREDIT ACCOUNTS

Current (open) include Credit Card(s)

CREDITORS NAME ADDRESS ACCOUNT# PAYMENT CURRENT

_______________________________________________________________ $___________ ___Yes ___No

Explain any “YES” answers on back with names and details

Has any signer ever been sued for bills? __Yes __No Has any signer ever been sued for eviction? __Yes __No

Has any signer ever been bankrupt? __Yes __No Has any signer ever been guilty of a felony? __Yes __No

Has any signer ever broken a lease? __Yes __No Is the total move-in amount available now? __Yes __No

(rent & deposit)

Name in which utilities are now billed and account number__________________________________ #__________________

Applicant authorizes the owner to contact past and present landlords, employers, creditors, credit bureau, neighbors, and any other sources deemed necessary to investigate applicant.

All information is true, accurate and complete to the best of applicant’s knowledge. Owner reserves the right to disqualify tenant if information is not as represented.

ANY PERSON OR FIRM IS AUTHORIZED TO RELEASE INFORMATION ABOUT THE UNDERSIGNED UPON PRESENTATION OF THIS FORM OR A PHOTOCOPY OF THIS FORM AT ANY TIME.

X__________________________________________________________ ______________________________________

APPLICANT DATE

Rental Application.pdf