Personal Information

By checking this box, I acknowledge that this form is not a lease or tenancy agreement, and does not grant any right to an Applicant to occupy the premises.

First name

Last name

Current Address

Phone

Date

Year

Month

Day

Drivers Licence No:

Vehicle Type:

Names, Relationship & Ages of all persons who will occupy the Premises

List any animals which will occupy the Premises:( Pet Deposit Required)

Residential History

1. Name:

Address

Phone:

2. Name

Address

Phone:

Current Land Lord (Name):

Current Land Lord (Address):

Current Land Lord (Phone):

Who paid rent:

Current Rent:

Reason for Leaving:

Date of Tenancy:

Previous Rental Addresses - List all over the past 3 Years: Address, Name of Landlord, Landlord Ph:

Personal References - Please List 3: Address, Name of Landlord, Landlord Ph:

Employment Information

Current Employer:

Contact Name:

Date Hired:

Phone:

Address:

Current Salary:

If less than 12 months at current position, please supply work information for the past year:

Requested Date of tenancy if your application has been approved

Year

Month

Day

If you are a successful applicant do you agree to allowing a current credit check before being considered for a lease.

Yes, I agree to Butler Place or its affiliates to run a credit check *You will be contacted before a Credit Check is run.

By checking, I certify all information given in this application to be correct and applicable to today’s date and give permission for The Butler Place and its affiliates to verify all information given. Including contacting former and current landlord