ROYAL LEPAGE RENTAL APPLICATION

RENTAL HISTORY
1) Address:
City:
Province:
Postal Code:
Landlord Name:
Phone Number:
Date In:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Out:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason for Moving:
2) Address:
City:
Province:
Postal Code:
Landlord Name:
Phone Number:
Date In:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date Out:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason for Moving:

EMPLOYMENT HISTORY
For :
Present Occupation or Source of Income:
Employer Name:
Employer Address:
Employer Phone:
Current Rate of Pay:
Start Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Prior Occupation or Source of Income:
Employer Name:
Employer Address:
Start Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
For :
Present Occupation or Source of Income:
Employer Name:
Employer Address:
Employer Phone:
Current Rate of Pay:
Start Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Prior Occupation or Source of Income:
Employer Name:
Employer Address:
Start Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Current Gross Household Income:
Per:
Personal References:
Phone:
Phone:
Phone:
Phone:

Tenancy Reference and Credit CheckPermission Form
I/We,
Hereby give Royal LePage South Country permission to call the contacts listed on this attached Rental Application for the purpose of screening me (us) as tenants. Personal questions may be asked that would help in establishing my suitability as a tenant. I (we) give permission for this authorization to be forwarded to our references, ensuring that they have full knowledge of this permission, as per the Privacy Act requirements. I (we) also give permission for a credit report to be requested on all adult applicants. By typing your name and Social Insurance Number you are giving your electronic signature for Royal LePage South Country to complete the necessary screening of verifying your suitability as a tenant.
Name:
SIN:
Name:
SIN:
Name:
SIN:
Should be Empty: