REFERRED BY
REQUESTED UNIT NUMBER
RENT
DEPOSIT
LEASE TERM: START DATE
END DATE
MONTH
DAY
CURRENT ADDRESS
CITY
POSTAL CODE
PHONE HOME
CELL
EMAIL
NUMBER OF OCCUPANTS
NUMBER OF PETS
TYPE OF ANIMAL
Name ADDRESS CITY
FROM TO
PHONE CONTACT NAME POSTAL CODE
RENT $ /MONTH
EMPLOYER
CURRENT POSITION
ADDRESS
SALARY
EMPLOYED SINCE
CONTACT NAME
PHONE
I, the undersigned, declare all of the above-mentioned information to be true, and I hereby authorize any individual (private investigator, credit bureau, my employer, my current or former landlord) to disclose personal information about me to the lessor, or his representative or agent, in order to assess this rental proposal, or for any modification, renewal, or extension of my lease. It is understood that all information provided on this form or obtained by the landlord and/or his representative are confidential. I further agree to sign the lease form as long as the request is accepted in the next 10 days.
DATE
Signature