Application To Rent An Apartment Page 2
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4UNIT 100-1420 TAYLOR AvENUE WINNIPEG, MANITOBA, CANADA R3N 1Y6
p 204 956.2739 f 204 956-5620
sUite rentAl AppliCAtion
Where did you hear about this suite:
Wpg Free Press
Renters Guide
Building Sign
Other (specify)
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Please Note: eACh AppliCAnt mUst fill oUt A sepArAte AppliCAtion
• no pets allowed • Security deposit payment must accompany this application. • The first month’s rent must be paid in full prior to occupancy.
cancels after application is approved.
• Security deposit becomes property of landlord and subject to fees if applicant
ApArtment being Applied for: Apartment Building:_____________________________ Suite #:_________
Bach
1 BR
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Occupancy Date: ___________________ Rent: $:_______________
Parking Stalls Required:
0
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2
2 BR
3 BR
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personAl informAtion:
Miss
Ms.
Mr.
Mrs.
First: _______________________ Middle: _______ Last: __________________________________
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Birth Date: __________________ S.I.N. - Canada ____________________ Drivers License #: _______________________________
(mm / dd/ yyyy)
Province (or State) of Issue
Home Phone #:
Work Phone #:
Cell Phone #:
Email:
present Address:
Apt.:_________ Street:_____________________________________ City:____________________________ Postal: ____________
Landlord:________________________ Phone Number:_________________ How Long? ______________ Rent Amount: $ ___________
preVioUs Address:
Apt.:_________ Street:_____________________________________ City:____________________________ Postal: ____________
Landlord:________________________ Phone Number:_________________ How Long? ______________ Rent Amount: $ ___________
CUrrent employer/ edUCAtionAl institUtion (if student):
Name:___________________________ Address:_______________________________ Phone Number: _______________________
Occupation:__________________________________ What’s your monthly gross income?___________________ How Long? _______
preVioUs employer: If current employer is for a time period of less than one year.
Name:___________________________ Address:_______________________________ Phone Number: _______________________
Occupation:__________________________________ What’s your monthly gross income?___________________ How Long? _______
oCCUpAnts: Names of other intended occupants of suite in addition to applicant.
1) Name: ________________________________________
Relationship: _____________________________ Age: ___________
(if under 18)
2) Name: ________________________________________
Relationship: _____________________________ Age: ___________
(if under 18)
ContACts: In case of emergency, please provide next of kin.
1) Name:____________________ Address:__________________________Phone:____________Relationship: ___________________
2) Name:____________________ Address:__________________________Phone:____________Relationship: ___________________
Do you have any outstanding monies owed to a previous landlord?
Yes
No
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Have you been evicted or mediated an eviction from a previous address under
your current name or any other name (maiden, etc.)?
Yes
No
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I understand that misrepresentation or omission of facts called for is cause for rejection of application or termination of lease.
In connection with the tenancy applied for, I hereby give Towers Realty Group Ltd. permission to contact current/previous landlords
and consent to a Credit Inquiry by Towers Realty Group Ltd. and/or a personal reporting agency.
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AppliCAnt’s signAtUre:______________________________________________ dAte:__________________________________
for offiCe Use only
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Bldg. #
Building Name
Address
Suite #
Postal Code
Month to Month
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Sublet
Last Name #1
First Name #1
Transfer From:
Last Name #2
First Name #2
Co-Signer/Guarantor Last Name
Co-Signer/Guarantor First Name
Move in Date
Lease Start
Lease Expiry
Security Deposit $__________________________
Date Paid: _______________________________
Monthly Rent
Rent Discount
Pro-Rated Rent
(mm/dd/yyyy)
Receipt#: _______________________________
Parking Rate
Locker Rental
debit
cash
cheque
SRA2011
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Parent category: Business