form updated September 19, 2009
Real Estate Central
(304) 552-4168

Rental Application
A separate application must be filled out for each tenant over 18 years old.
The $20.00 application fee and security deposit MUST accompany this application.
House/apt applying for _________________________________________
When you plan to move in if approved __________________________


PERSONAL
First, Middle & Last Name _________________________________________________________________
Maiden, married & all other names used (past or present)_________________________________________
Current address _________________________________________________
_________________________________________________
How long at this address? ____________________
Previous address ________________________________________________
_________________________________________________
How long at previous address? ____________________
Phone #(s) _____________________________________________________
Email ____________________________________________________
Social security #______________________________________
Date of birth _________________________________________
Drivers license #_________________________ Exp. __________
Other occupants                                                  Age                     Relationship
_______________________________        _______        __________________
_______________________________        _______        __________________
_______________________________        _______        __________________
_______________________________        _______        __________________
_______________________________        _______        __________________


INCOME
Current employer _________________________________________________
Dates of employment ___________________________
Position held  ____________________________________________________
Business address ________________________________________________
________________________________________________
Name & title of supervisor __________________________________________
Phone number(s) of supervisor ______________________________________
Monthly gross income ___________________________

Previous employer _________________________________________________
Dates of employment ___________________________
Position held  ____________________________________________________
Business address ________________________________________________
________________________________________________
Name & title of supervisor __________________________________________
Phone number(s) of supervisor ______________________________________
Monthly gross income ___________________________

Other income to be considered _____________________________________________________________
_____________________________________________________________________________________


LANDLORDS FOR PAST 5 YEARS
Name and phone number(s)           Address                                     Dates rented    Rent amt        Reason left
________________________        ____________________        _________      ________   ________________
________________________        ____________________        _________      ________   ________________
________________________        ____________________        _________      ________   ________________
________________________        ____________________        _________      ________   ________________

PETS
Type ____________________        Breed______________        Age_______________       Weight ________
Type ____________________        Breed______________        Age_______________       Weight ________
Type ____________________        Breed______________        Age_______________       Weight ________
Type ____________________        Breed______________        Age_______________       Weight ________


OTHER INFO
Have you ever filed a petition for bankruptcy?     ____________
Have you ever been evicted from any tenancy?  ____________   
Have you ever not paid any rent when due? ______
Have you ever been convicted of a crime?  ____________
If you answered yes to any of the above, please explain in detail: ___________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Please tell us about your credit? _____________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________


I declare that the foregoing information is true and correct and authorize verification of the information.  I also
authorize Real Estate Central to obtain a credit report and background check and to thoroughly check all
references by former landlords.  I further agree that Management may terminate any agreement entered into in
reliance on any misstatement made above.

I agree that I have read the standard lease used by Real Estate Central and agree to the terms if approved as a
tenant.  I also agree to start the lease within 2 days of being approved or as soon as the unit is available for rent.  
I understand that my deposit check will be returned if I am not approved.  If I am approved, the deposit check will
be cashed immediately upon approval and will not be refundable.


_________________________________________          _______________
signature                                                                                        date

_______________________________________________________________________________
For office use only
Checked DL for name spellings ___ address match ___  photo match ___
Checked pay stub for company _________________ name match ___ address match ___
check amt & period____________ YTD _________other _______________________________
All applicants will be
evaluated on the
following criteria
________________

credit

collections

criminal record

sex offender record

references

income & employment

rental history

financial ability
(rent must not exceed
40% of income)

evictions

identification

home visit
The following items
will be required for
each tenant over 18
_________________

completed rental
application

$20.00 application fee

drivers license or other
state issued photo ID
card

2nd form of ID

copy of last pay stub
Old World
Investments, LLC
does not discriminate
based on any of the
following
________________

race

color

religion

sex

handicap

familial status

national origin

ancestry

blindness

sexual orientation
Please write
separate checks for
the deposit and
application fee(s).  If
your application is
not approved the
deposit check will be
returned to you.