Date: *


Your Name: *


Your Email: *


Premesis you are applying for: *
Moose Jaw Farmhouse 703 King Street Rosetown 710 George Street Rosetown 124 3rd Ave East Rosetown 809 Main Street Rosetown 1 bedroom suite Rosetown 2 bedroom suite Rosetown 3 bedroom suite Rosetown 8 acre farm Rosetown (St Andrews County) see note

Number of adults and children who will be living at this unit: *


When do you need to occupy this unit? *


PERSONAL INFORMATION:
*


Gender: *
male female

Age: *
18 - 22 23 - 27 28 - 33 34 - 42 43 + up

Phone number: *


Present Address: *


How long have you been at this address? *


Present Landlord's name and phone number: *


Present Landlord's address: *


Previous Address, if less than 2 years at current address: *


Previous Landlord's name and address: *


How long were you at your previous address? *


Nearest Next of Kin: *


Phone # of Next of Kin: *


Present Employer: *


Your Position: *


Employer Phone Number: *


Employer Address: *


How long have you been with this Employer? *


Income level per year in $: *
below 10,000 10,001 - 15,000 15,001 - 25,000 25,001 - 35,000 35,001 or above

Name of Bank: *


Branch Address of Bank: *


Reference #1 - Please include full name and phone number: *


Reference #2 - Please include full name and phone number: *


Reference #3 - Please include full name and phone number: *





Gender:
male female

Age:
18 - 22 23 - 27 28 - 33 34 - 42 43 + up

Phone number:


Present Address:


How long have you been at this address?


Present Landlord's name and phone number:


Present Landlord's address:


Previous Address, if less than 2 years at current address:


Previous Landlord's name and address:


How long were you at your previous address?


Nearest Next of Kin:


Phone # of Next of Kin:


Present Employer:


Your Position:


Employer Phone Number:


Employer Address:


How long have you been with this Employer?


Income level per year in $:
under 10,000 10,001 - 15,000 15,001 - 25,000 25,001 - 35,000 over 35,000

Name of Bank:


Branch Address of Bank:


Reference #1 - Please include full name and phone number:


Reference #2 - Please include full name and phone number:


Reference #3 - Please include full name and phone number:


Additional info: