Property Address

Date of Occupancy

Principal Applicant Information

First Name *

Last Name *

Phone *

Email *

Date of birth

Social Security Number

Number of Children *

Ages

Will they Be Occupants in The Unit?

Yes

Present Address *

City *

Province *

Postal code

Present Landlord

Reason For Leaving

Occupation

Employer *

Employer's Phone Number *

How Long *

Monthly Income *

Bank

Bank Address

Co-Applicant Information

Co-Applicant First Name *

Co-Applicant Last Name *

Co-Applicant Social Security Number

Co-Applicant Birthdate

Co-Applicant Occupation

Co-Applicant Employer *

Co-Applicant Phone Number *

Co-Applicant Monthly Income *

Year / Make of Vehicle

License Number

Financed With

Balance Owed

Credit References

Reference 1 Name *

Reference 1 Phone *

Reference 2 Name *

Reference 2 Phone Number *

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Relationship

Note: The term of occupancy is to begin and end on a calendar-month basis. ALL REGULAR RENTAL PAYMENTS ARE PAYABLE IN ADVANCE ON THE FIRST OF EACH MONTH.

I agree that all information is accurate to the best of my knowledge. You are hereby given permission to perform whatever checks you deem necessary and I/we authorize anyone contacted by Helm Property Management to release any information requested.