Residential Application Form

Location Applying for:
1. Tenant Information
Full Name:		Drivers License No:
Address:		Social Insurance No:
City:		Date of Birth:
Province:		Home Phone Number:
Postal Code:		Cell Phone Number:
Email Address:		Fax Number:

Present Employer:		Supervisor's Name:
Address:		Work Phone No:
Gross Monthly Salary:		Additional Income (specify source):

Previous Employer:		Supervisor's Name:
Address:		Work Phone No:

2. Rental Information
Address:		Landlord Name:
City:		Landlord Phone No:
Province:		Length of Tenancy:
Postal Code:		Reason for leaving:

Address:		Landlord Name:
City:		Landlord Phone No:
Province:		Length of Tenancy:
Postal Code:		Reason for leaving:

Full Names of all individuals (including children) who will be occupying the premises:

Will you be having Pets (Specify Age/Neutered or Fixed/Type):

Have you ever been evicted, sued for nonpayment of rent, or breached a lease (if so, please explain)?

Do you smoke?		yes no
Are you a student?		yes no
Have you ever been convicted of a crime?		yes no


3. References (The folllowing should not be related to you in any way or friends)
Name:		Ph:	Relationship:
Name:		Ph:	Relationship:
Name:		Ph:	Relationship:

	I certify that the above information is true and complete. I authorize the verification of this information through checking the above references. I also authorize Coldwell Banker Horizon Realty to obtain a credit report through their business affiliate Mortgage Alliance Homeline Mortgage for purposes related to this application.