Rental Application

I/We hereby make application to rent 220 Bartholomew Street, Brockville, from the Date , at an amount of $ to become due and payable in advance on the first day of each and every month during my tenancy.

I am looking to rent a...

1.Name First Name Last Name Date of Birth Date
Occupation Type a label

2.Name First Name Last Name Date of Birth Date
Occupation Type a label

3.Other Occupants
Name            Relationship      Age
Name            Relationship      Age
Name            Relationship      Age

Do you have any pets? Yes No If yes, please describe
Why are you vacating your present place of residence?

LAST TWO PLACES OF RESIDENCE
Address   Street Address   Address Line 2   City   Province   Postal Code
From   Date   To   Date
Name of Landlord
Phone # of Landlord      Phone Number

Address   Street Address   Address Line 2   City   Province   Postal Code
From   Date   To   Date
Name of Landlord
Phone # of Landlord      Phone Number

Occupant #1
Present Employment
Occupation:
Employer:
Business Address:
Business Phone:
Position Held:
Length of Employment:
Name of Supervisor:
Current Monthly Salary:

Prior Employment
Occupation:
Employer:
Business Address:
Business Phone:
Position Held:
Length of Employment:
Name of Supervisor:
Monthly Salary:

Occupant #2
Present Employment
Occupation:
Employer:
Business Address:
Business Phone:
Position Held:
Length of Employment:
Name of Supervisor:
Current Monthly Salary:

Prior Employment
Occupation:
Employer:
Business Address:
Business Phone:
Position Held:
Length of Employment:
Name of Supervisor:
Monthly Salary:

FINANCIAL OBLIGATIONS
Payments to:      Amount:
Payments to:      Amount:

AUTOMOBILE(S)
Make:      Model:      Year:   License Plate No:
Make:      Model:      Year:   License Plate No:

Additional Information (Optional):Please include any relevant details you believe may support your application (e.g., special circumstances, rental history, references, etc.).

The applicant represents that all statements above are true and correct. The applicant is hereby notified that a consumer report containing credit and/or personal information may be referred to in connection with this rental. The applicant authorizes the verification of the information contained in this application and information obtained from personal references. This is not a Rental or Lease Agreement. In the event that this application is not accepted, and deposit submitted by the applicant shall be returned.

Signature
Signature of Applicant
Date   Date
Phone #
Email

Signature
Signature of Applicant #2
Date   Date
Phone #
Email