Application Information

Current Street Address

Current Mailing Address (If different from above)

Previous Address

Other Occupants

Pets

Vehicles / Smoking

Employment and Income Information

Applicants Consent

Confidential

The applicant declares all above statements to be true and authorizes CENTURY 21 Lakeside Realty Ltd. Property Manager to contact the references named in this application.

The applicant hereby consents for collection, use and disclosure of the personal information provided in accordance with the Privacy Policy of CENTURY 21 Lakeside Realty Ltd.

CENTURY 21 Lakeside Realty Ltd. does not disclose any information about its residents or clients to other sources, unless consent is given or it is otherwise required or authorized by law.

I understand that I may decline or object to having my personal information collected, used or disclosed for the above purposes. I also understand that I may revoke this consent at any time by submitting a written notice. By declining, objecting to or revoking consent to the collection, use and disclosure of my personal information I may be forfeiting my eligibility for residency with CENTURY 21 Lakeside Realty Ltd.

Date:

Applicant Name:

Applicant Signature:

PLEASE USE ANOTHER FORM FOR EACH ADDITIONAL APPLICANT.
Any falsification of this form will result in termination of your lease