| Full Name | |
| Date of Birth | |
| Cell Phone # | |
| Current Home Phone # | |
| Email Address | |
| Social Insurance Number (or Driver's Licence #) |
| Current Full Address | |
| Date Moved In | |
| Rent $ | |
| Landlord / Agent |
| Previous Address | |
| Date Moved In | |
| Rent $ | |
| Landlord / Agent |
| Have you ever declared bankruptcy? | |
| Employer's name | |
| Employer's Phone # |