We will advise you by e-mail within one working day if the type of apartment you request is not available on the move-in date you stipulate. 

Name of Complex: Roxalana Hills Apartments     City & State: Dunbar, WV Please Select: 1 2 Bedrooms   Ground Upper Level Requested Move-In Date:      Number of Occupants:

RENTAL APPLICATION

The applicant hereby agrees to execute a lease for apartment (location to be assigned) for a term of one (1) year commencing on the first full calendar month apartment becomes occupied. The monthly rental of (Rental rate as listed on web site. The true rate of the apartment may vary from rate listed on web site due to discounts or added amenities. Applicant will be contacted by e-mail advising what apartments are available and their rental rate.) is payable monthly in advance on the first day of each month of said term.

In the event the rental application is approved, the owner or agent may apply the deposit of (Security deposit will be the deposit rate listed on web site for size of apartment requested) on account of security due or to become due. If the applicant cancels the application within three working days of forwarding this electronic application, the applicant shall be entitled to have the deposit returned. If the application is not cancelled within three working days and the application is approved, the applicant will have 10 days to sign the lease after notification of acceptance. If the applicant declines the apartment after notification of acceptance the deposit made herewith is to be retained by owner as liquidated damages incurred as a result of owner not having been able to rent the apartment to another party during this time.

The applicant has read the foregoing and certifies that the facts in the accompanying rental application are true and correct and that the rental application is submitted for the purpose of inducing approval of this application in the applicant's behalf. In the event this application is not approved, the applicant shall be entitled to have the return of the deposit made and no more, and all rights of the applicant shall there upon terminate and end absolutely. The $25 fee to process this credit application is not under any circumstances refundable.  We will contact you to secure payment for the application fee and security deposit before processing the application.

1. PERSONAL INFORMATION	APPLICANT	coAPPLICANT
Name
Date of birth
Social Security #
Present Address
City, State, Zip
Home Phone
Monthly Payment
Years at Address
Reason for Moving
Landlord/Mtg. Holder
Contact Phone
Previous Address
City, State, Zip
Years at Address
Landlord/ Mtg. Holder
Contact Phone
Were You Ever:
Evicted from a Residential Property?	NoYes	NoYes
Convicted of a Felony?	NoYes	NoYes
Relative not living with you (to be contacted in case of an emergency)
Phone Number
2. EMPLOYER INFORMATION	APPLICANT	coAPPLICANT
Occupation
Employed By
Date Started
Street Address
City, State, Zip
Employer Phone
Immediate Supervisor
Gross Weekly Income
Previous Employer
Employer Phone
3. CREDIT INFORMATION	APPLICANT	coAPPLICANT
Bank Name
Address
City, State, Zip
Checking Account #
Savings Account #
4. AUTOMOBILE INFORMATION	APPLICANT	coAPPLICANT
Make & Model of Vehicle
Vehicle Year
License Plate #
State Issued
Is Vehicle Being Financed?	NoYes	NoYes
Name of Financier
Account Number
Address
City, State, Zip
5. PET INFORMATION	(Our community does not accept dogs)
	APPLICANT	coAPPLICANT
Do You Own a Pet?	NoYes	NoYes
Type/Description
Pet Height
Pet Age
A security deposit of $100 per pet is required.
6. **Please list name and age of others living in the apartment**
Name Age Name Age Name Age Name Age
To facilitate investigation in connection with the processing of this application the applicant has furnished the names of references, and authorizes and directs said persons to give any information concerning me, hereby assuming full responsibility for same and waiving all rights of action for any consequences as a result of such investigation. I authorize and direct names of references I provided to give any information to Roxalana Hills Apartments so that they can facilitate my application.   Yes     No By typing in your name(s) below, you are agreeing to submit this information using an "electronic signature" as your method of providing accurate and truthful information for this document. Applicant Electronic Signature Date   coApplicant Electronic Signature Date   Applicant's E-mail Address