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RENTAL HISTORY: Present Address: City/Province: Move-In Date: Present Landlord’s Name: Landlord’s Phone Number:

Move-Out Date:

Postal Code: Amount of Rent Paid:

Prior Address: City/Province: Move-In Date: Prior Landlord’s Name: Landlord’s Phone Number:

Move-Out Date:

Postal Code: Amount of Rent Paid:

EMPLOYMENT HISTORY: Are you a student? Yes: Present Employer: Length of Employment: Previous Employer: Length of Employment: Income Sources if not employed: 1) No:

Do you work: Full Time:

Part Time:

2)

Bus. Phone #: Occupation: Bus. Phone #: Occupation:

EMERGENCY CONTACT: Name: Address: Relationship:

City/Province:

Phone Number:

In the event of serious illness or death of resident, the above person is ( authorized to enter the apartment and remove all contents.

) or is not (

)

HOW DID YOU HEAR ABOUT THIS UNIT? Newspaper:

Internet:

Sign:

Other:

Referral:

Name & Apt. # of Referral:

ALL UNITS RENTED AS VIEWED: If there are any specific repairs or maintenance work you would like, please indicate in the space provided below. We reserve the right to repair ONLY those items WE determine necessary and have up to 30 business days from the date of move-in to complete said repairs.

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