Waitlist Request Form
Thank you for you interest in applying for the Townhomes located on Simon's Lane in Vineland Ontario. Please be advised the townhouses are associated with a LifeLease policy. For more information please visit the Vineland Park Estates tab on our website umh.ca. Please reach out to 905-562-7385 with any further questions.
Name
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First Name
Last Name
Birth Date
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Year
Name
First Name
Last Name
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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28
29
30
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Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
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Year
Phone Number
*
Email Address
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Marital Status
Single
Married
Divorced
Widow/er
Church Affiliation and Minister
ex. name of church rev john doe
Preferred Date of Occupancy
-
Month
-
Day
Year
ex. 00-00-2028
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Emergency Contact
Children or Next of Kin
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Relation
*
Ex. Daughter
Emergency Contact Phone Number
*
Please enter a valid phone number.
Emergency Contact Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Signature
*
Signature
Apply
Apply
Should be Empty: