Rent Drumheller

********************************************************************

CENTURY 21 POWER REALTY APPLICATION TO RENT
LANDLORDS REFERENCE AND INFORMATION SHEET

PLEASE FILL IN THE BLANKS AND SUBMIT IN PERSON
   to 145 3rd Avenue West, Drumheller, AB T0J0Y0


Applicant's full name ________________________________

Age_____________  D.Lic. #___________________________

Applicant's phone number____________________________

Cell number_________________________ voicemail?  Y / N

email address ______________________________________

Currently employed at _______________________________

Current employer's name ____________________________

Employed there for __________________________ months

Phone ______________________________________________

Former employer ____________________________________

Reason Left _________________________________________

From _____________________to ________________________

Phone ______________________________________________

Applicants present address ___________________________

_____________________________________of months  _____  

Have you given notice to your current landlord?      Y  / N 

Pets owned by applicant ______________________________

Spouse's full name __________________________________

Ages of Children  ___________   ___________   __________

Spouse Employed by _________________________________

Phone ______________________________________________

Credit reference: (list bank, car loans, & credit cards, etc.)

1. __________________________________________________

2.___________________________________________________

Personal References:

1. Lawyer ____________________________________________

Lawyer's Phone _______________________________________


2. Parents ____________________________________________

Parent's Phone _______________________________________

In the event of some emergency that would prevent you
from paying rent, please provide the name of at least
one person who could be called on for assistance.

Name________________________________________________

Phone _______________________________________________

Any past payment problems that we might discover?  Y / N

Can you pay damage deposit today to hold premises? Y / N

I/WE THE UNDERSIGNED, WARRANT THE TRUTH,
COMPLETENESS AND ACCURACY OF THE FORGOING
INFORMATION AND HEREBY AUTHROIZE AND
CONSENT TO CENTURY 21 POWER REALTY LTD.
OBTAINING INFORMATION ABOUT ME/US TO
CREDIT BUREAUS AND OTHER PERSONS WITH
WHO I/WE HAVE OR PROPOSE TO HAVE FINANCIAL
DEALINGS OF IF IT BELIEVES THE DISCLOSURE IS
REQUIRED BY LAW. I/WE AGREE THAT INFORMATION
SO RECEIVED AND THIS APPLICATION MAY BE
RETAINED BY CENTURY 21 POWER REALTY LTD.


Dated this ________ day of ___________________ 20 ____

Signature_____________________________________________       



Signature (co-applicant)________________________________