Rental Application

This is an application to rent: _____________________________________________________________

Name: __________________________________________ Date of Birth: __________________________

Tel: ______________________________ Email: _______________________________________________
Current Address: ________________________________________ City: ___________________________
Dates of Tenancy: _______________________________________________________________________
Name of Landlord: _____________________________ Landlord Phone: ___________________________
Reason for Leaving: _____________________________________________________________________
SSN(Optional): __________________________________________________________________

Additional Occupants:
Name: _______________________________________________________ Age: _____________________
Name: _______________________________________________________ Age: _____________________
Name: _______________________________________________________ Age: _____________________

Pets: YES NO Describe: __________________________________________________

Smoking: YES NO Describe: __________________________________________________

Employment Status & Income Verification:

Occupation: _______________________________________________ Wage: _______________________
Company: ______________________________________________________________________________
How long have you worked at this company? __________________________________________________
Other income description (eg. Disability, Income Assistance, Savings): ____________________________________

Vehicle Information:
Make: ___________________________ Model: _________________________ Year: ________________

References:
1. Name: _______________________________________ Phone: _______________________________
Relationship (previous landlord, employer): __________________________________________________
2. Name: _______________________________________ Phone: _______________________________
Relationship (previous landlord, employer): __________________________________________________

I hereby state that the information contained herein is true and I authorize my References as listed
above to release information regarding my employment and/or past/current tenancies. I also authorize a
credit check to be conducted.

NB: Kindly attach the front and back copies of your Drivers License.
Signed: _______________________________________ Dated: ___________________________________