Rental Application Form - Dauphin Manitoba Rentals

Applicant Information

First Name(*)

Please let us know your name.

Last Name(*)

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Age(*)

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Phone Number(*)

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Email(*)

Please let us know your email address.

Will Any Other People Live With You(*)

Yes No

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How Many?

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Additional Occupant 1 Name(*)

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Additional Occupant 1 Age(*)

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Additional Occupant 2 Name(*)

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Additional Occupant 2 Age(*)

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Additional Occupant 3 Name(*)

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Additional Occupant 3 Age(*)

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Additional Occupant 4 Name(*)

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Additional Occupant 4 Age(*)

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Additional Occupant 5 Name(*)

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Additional Occupant 5 Age(*)

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Driver's License Number(*)

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Current Address(*)

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How Long?(*)

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Current Rent(*)

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Current Landlord(*)

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Landlord Phone Number(*)

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Are you required to give notice before leaving? (*)

Yes No

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How Much Notice?(*)

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If less than 2 years at present address, list previous address information below:

Previous Address

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How Long?

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Previous Rent

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Employer Name(*)

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How Long Have You Worked For Them?(*)

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Monthly Salary(*)

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Supervisor Name(*)

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Supervisor Phone Number(*)

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Are You On Any Kind of Assistance?

Yes No

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Supervisor/Case Worker Name(*)

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Supervisor/Case Worker Phone Number(*)

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May We Call Your Supervisor/Case Worker

Yes No

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Why Not?(*)

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Reference Information

Reference 1 Name(*)

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Reference 1 Phone Number(*)

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Relationship To Reference 1(*)

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Reference 2 Name(*)

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Reference 2 Phone Number(*)

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Relationship To Reference 2(*)

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Additional Information

What Do You Want To Rent?(*)

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Minimum Number of Bedrooms Required(*)

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What Is The Maximum Monthly Rent You Can Pay? (Including Utilities)(*)

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Notes/Comments(*)

Please let us know your message.

The above information is, to the best of my knowledge, true and correct.

Important information for the Applicant: The information collected in this application will be kept strictly confidential, and will be used only to evaluate your suitability as a tenant. Applications are reviewed and accepted at the owner's discretion. Filling out this rental application does not guarantee a rental agreement will be reached.

Signature(*)

Sign Above

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