DATE OF BIRTH YEAR

MONTH

DAY

RENTAL HISTORY

CURRENT LANDLORD

FORMER LANDLORD

PROFESSIONAL INFORMATION

OTHER SOURCES OF REVENUE

OTHER REVENUE SOURCE:
CSSTEMPLOYMENT INSURANCEPENSION PLANThe future resident agrees to provide the owner or one of the owners representatives with a copy of his or her pay slip to confirm the listed salary andor anyWELFARE

The future resident agrees to provide the owner or one of the owner’s representatives with a copy of his or her pay slip to confirm the listed salary and/or any government allocations.

EMERGENCY REFERENCES

1st PERSON

Name

ADDRESS

CITY

POSTAL CODE

PHONE

LINKS

2nd PERSON

Name

ADDRESS

CITY

POSTAL CODE

PHONE

LINKS

During my absence or in the event of an emergency (fire, theft, flood, etc.), I authorize the owner to contact the above-mentioned individuals.

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.

RENTAL REQUEST FORM

FUTURE RESIDENT

PERSONAL INFORMATION

RENTAL HISTORY

CURRENT LANDLORD

FORMER LANDLORD

PROFESSIONAL INFORMATION

OTHER SOURCES OF REVENUE

EMERGENCY REFERENCES

1st PERSON

2nd PERSON