Residential Application Form

When would you like to move in? (mm/dd/yyyy)
Select the type of unit requested?
 2 Bedroom    3 Bedroom    4 Bedroom  

Applicant #1
First Name
Last Name
SIN Number
Date of Birth (mm/dd/yyyy)
Address
Address Line 2
City
Province/State
Postal Code
Country
Home Phone Number (XXX-XXX-XXXX)
Cell Phone Number (XXX-XXX-XXXX)
Email
Employer and/or source of income
Monthly Income before Deductions
$
At your current address do you:
 Rent    Own    Other  
Moving reason (Other Comments)
Have you previously lived at Southport?
 Yes    No
Will there be a co-applicant?
 Yes    No
Will there be other occupants?
 Yes    No

Will a pet be occupying the residence with you?
 Yes    No

I/We hereby declare that the foregoing information is true and complete. I/We understand that any false information or omissions may result in the refusal of my/our application. I/We hereby consent to a credit check and personal investigation. I/We acknowledge that this application does not constitute an agreement on the part of Southport Aerospace Centre Inc. or its agent to provide me/us with accommodation. I/We acknowledge that this application becomes the property of Southport

  I/we have read and consent to the above conditions
Name:

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