Pay Rent

(304) 522-6252
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(304) 633-5187
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414 11th Street | Huntington, WV 25701

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Rental Application

Date of Application

Desired Date of Occupancy

Type and Size of Apartment Wanted (No. of Bedrooms, etc.)

Personal Information

Applicant's Full Name

Date of Birth

Social Security No.

Home Phone

Driver's Lic. No./State

Work Phone

E-mail

Cell Phone

Co-Applicant's Full Name

Date of Birth

Social Security No.

E-mail

Driver's Lic. No./State

Home Phone

Relationship

Cell Phone

List All Other Residents

Full Name, Relationship to You, Date of Birth (entries separated by a ";")

How Did You Hear About Our Property?

Residence History

Present Address

Present Telephone

Dates From

To

Present Landlord or Mortgage Co.

Monthly Payment $

Telephone

Reason for Moving

Previous Address

Dates From

Previous Landlord or Mortgage Co.

Monthly Payment $

To

Telephone

Reason for Moving

Employment Information

Present Employer

Dates From

Employer's Address

To

Telephone

Banking

Bank Name & Branch

Telephone

Other Information

Total Number of Vehicles (Including Company Vehicles)

Make/Model

Year

Color

Tag No./State

Other Car, Motorcycle, etc.

Total Gross Monthly Household Income $

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 Lease?

Yes
No

Been sued for damage to rental property?

Yes
No

Declared Bankruptcy?

Yes
No

In Case of Personal Emergency, Notify

Relationship

Address

Home Phone

Work Phone

I hereby make application for an apartment and certify that this information is correct. I authorize you to contact any references that I have listed. I also authorize you to obtain my consumer credit report from your credit reporting agency, which will appear as an inquiry on my file.

Applicant's Signature

Co-Applicant

Date Signed

Application Fee

Application Fee - $25.00

Convenience Fee

$3% processing fee

Total

$0.00

Payment Information *

Cardholder Name

VISA

MasterCard

American Express

Discover

JCB

Card Number

Expiration Date

Security Code

Tenant Name

Tenant Address

Unit #

Tenant Phone

Tenant Email

Rent *

Convenience Fee

$3.5% processing fee

Total

$0.00

Payment: Stripe *

Cardholder Name

VISA

MasterCard

American Express

Discover

JCB

Card Number

Expiration Date

Security Code