Lily Schwartz- Broker
121 Main St- 2nd Floor
Box 534, Flin Flon, Manitoba, R8A 1N4
Phone: (204) 687-8530 Fax: (204) 687-4854 Toll Free: 1-877-687-8530
APPLICATION FOR ACCOMMODATION
Our agency levies a $45.00 registration fee upon finding suitable accommodation.
Date: ________________________
NAMES OF APPLICANT AND CO-APPLICANTS:
1. ___________________________________ Birthdate: _________________________
2. ___________________________________ Birthdate: _________________________
TELEPHONE NUMBER FOR CONTACT: Home: __________ Business: _________
TYPE OF ACCOMODATIONS REQUIRED (circle):
1 2 3 4 5 Bedroom – House // Apartment // Studio - (Bachelor) // House Trailer
When? ____________________________
District? ___________________________
Price Range? _______________________
DO YOU REQUIRE? (Yes or No)
Fridge/Stove _________
Parking _________
Applicant
Co-Applicant
Do you smoke?
Yes _____
No _____
Yes _____
No _____
Are you a homeowner?
Yes _____
No _____
Yes _____
No _____
Are you a pet owner?
Yes _____
No _____
Yes _____
No _____
If you are a pet owner, what kind of pet do you have and what size?
Applicant
Present Address:
(city, town, etc)
Present Landlord:
How Long?:
Present Landlord's
Telephone Number:
Previous Address:
(city, town, etc)
Previous Landlord:
How Long?
Previous Landlord's
Telephone Number:
Co-Applicant
PLEASE LIST TWO CHARACTER REFERENCES WHO ARE NOT RELATED TO
YOU
(Applicant)
1. Name
Phone #
Location
2. Name
(Co-Applicant)
1. Name
2. Name
Phone #
Location
Phone #
Location
Phone #
Location
NAME EVERY PERSON TO OCCUPY RENTAL UNIT:
Name
Age
Relationship
Applicant
Co-Applicant
Current Employer:
Position:
How Long:
Monthly Income:
Previous Employer:
Location:
Position:
How Long:
Credit Reference:
Credit Reference:
Credit Card:
Credit Card:
This information, if not supplied, disqualifies applicant for consideration.
Number of Automobiles: _________ License Plate # ____________ Province: ____
Make/ Model/ Year: __________________________ Driver’s License #: __________
HAVE YOU EVER:
1. Been evicted from tenancy? YES ______ NO ______
2. Willfully or intentionally refused to pay rent when due? YES ______ NO ______
3. Rented any accommodation through this agency? YES ______ NO ______
CONSENT:
I/ We authorize TRIAD REALTY to obtain such factual and investigative information
regarding me/us as it deems necessary for its purpose and consent to making inquiries of
others.
Date: __________________
Signature: ______________________________________