Name *

First Name

Last Name

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Occupant 1

First Name

Last Name

Over 19?

Yes

No

Occupant 2

First Name

Last Name

Over 19?

Yes

No

Occupant 3

First Name

Last Name

Over 19?

Yes

No

CurrentAddress *

Current Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Current Landlord or Manager Phone Number *

(###)

###

####

Previous Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Supervisor Phone Number

(###)

###

####

Do you insure your belongings and are you insured for third party liability?

Yes

No

Have you ever been convicted of a criminal offence?

Yes

No

Have you ever been served a Notice to End Residential Tenancy?

Yes

No

Do you own any pets

Yes

No

Are you or any of the potential occupants smokers?

Yes

No

Phone

(###)

###

####

Reference Name

First Name

Last Name

Reference Phone

(###)

###

####

Reference #2 Name *

First Name

Last Name

Reference #2 Phone *

(###)

###

####

I have answered all of the questions truthfully to the best of my ability. *

Yes

CONSENT: FOR THE PURPOSE OF DETERMINING WHETHER MY/OUR APPLICATION FOR TENANCY IS ACCEPTABLE. I/WE HEREBY CONSENT TO THE LANDLORD OBTAINING CREDIT/ PERSONAL INFORMATION REPORTS ON ME/US (INCLUDING A SPOUSE) FROM ONE OR MORE CONSUMER REPORTING AGENCIES OR FROM OTHER SOURCES OF SUCH INFORMATION. I/WE AUTHORIZE THE REPORTING AGENCIES AND OTHER PERSONS TO DISCLOSE INFORMATION ON ME/US TO THE LANDLORD OR LANDLORD'S AUTHORIZED AGENT. *

Yes

I understand that putting false information in this application could be fraudulent misrepresentation. *

Yes

this

Date

MM

DD

YYYY

I (enter your name below) hereby authorize the Landlord or its Manager to both obtain credit information from a credit reporting and to verify the information provided herein. *

First Name

Last Name