West Virginia Rental Application
This Rental Application is intended for use in the state of West Virginia and is designed to gather necessary information from potential tenants. It complies with the Fair Housing Act and the West Virginia Residential Landlord and Tenant Act. Please complete all sections of this application to be considered for tenancy.
Applicant Information
Name: ___________________________________
Date of Birth: ___________________________
Current Address: _________________________
City:____________ State:____ Zip:_________
Phone Number: ___________________________
Email Address: ___________________________
Employment Information
Current Employer: ________________________
Employer Address: ________________________
City:____________ State:____ Zip:_________
Position: _______________________________
Monthly Income: __________________________
Supervisor Name: ________________________
Supervisor Phone Number: _________________
Rental History
Current Landlord: ________________________
Landlord Phone Number: ___________________
Previous Address: ________________________
City:____________ State:____ Zip:_________
Previous Landlord: ______________________
Landlord Phone Number: ___________________
References
Please provide at least two personal references not related to you.
- Name: _______________________________
- Relationship: ________________________
- Phone Number: ________________________
- Name: _______________________________
- Relationship: ________________________
- Phone Number: ________________________
Additional Information
Please describe any pets: _________________
Will you have anyone else living with you? ____ If yes, please provide their names and relationships: ___________________________________________________________________
Do you smoke? ____ Yes ____ No
Have you ever been evicted? ____ Yes ____ No If yes, please explain:____________________________________________________
Have you ever been convicted of a crime? ____ Yes ____ No If yes, please explain:___________________________________________
By signing below, the applicant grants permission to conduct a background and credit check. The applicant affirms that all information provided in this application is true and accurate to the best of their knowledge.
Signature: _______________________________
Date: ___________________________________