Housing Application - Coopérative Rochelandaise

Choice of housing

2-bedroom unit
3-bedroom unit
Adapted unit (reserved for existing members)

Candidate No. 1

Candidate name no. 1

First

Last

Date of birth

Phone

E-mail

Candidate No. 2

Candidate name no. 2

First

Last

cars address information

Date of birth

Phone

E-mail

Do you have children?

Yes
No

Your current address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Employment information

Current employer

Company name

Employer's address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Position held

Name of your superior

Annual income

Employment status

Full-time
Part-time work
Permanent

Employed since

Number of hours per week

Phone

Previous employer

Company name

Employer's address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Position held

Name of your superior

Annual income

Employment status

Full-time
Part-time work
Permanent

Employed since

Number of hours per week

Phone

Banking information

Name of banking institution

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Number of cars

References

Candidate no. 1

Name

Phone

Link

Candidate no. 2

Name

Phone

Link

Declaration

I certify that this information is complete and true and that I have in no way misrepresented, falsified or omitted any facts that could invalidate this form or influence the decision of the landlord. I am aware that a false declaration may result in the cancellation of the lease.

I authorize the Lessor and its representatives to obtain or exchange personal information with any personal information agent, financial institutions, employers, landlords or other institutions and persons mentioned above for the purpose of establishing my solvency and my ability to meet the obligations of the lease.

Initials

Candidate No. 1

Candidate No. 2

Signature – candidate No. 1

Clear Signature

I will respect the laws and regulations of the Rochelandaise Cooperative.

Signature – candidate No. 2

Clear Signature

I will respect the laws and regulations of the Rochelandaise Cooperative.

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Do you prefer to fill out this form on paper?

Candidate No. 1

Candidate No. 2

Child's name and age

Employment information

Current employer

Previous employer

Banking information

References

Candidate no. 1

Candidate no. 2

Declaration

Initials