Doug Derkson Selling Your Neighborhood One yard at a Time

604-351-8899
Doug Derkson
Cell:604-351-8899
Fax:604-507-2899
Office:604-538-2125

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Rental Application
*indicates required fields.
Please be aware if your application is successful that there will be regular inspections of this property in accordance with RTO rules and regulations
Property Address:*
If approved preferred move in date:
Applicants Name:*
Date of Birth:*
SIN #:*
Applicants Phone#:*
Applicants email:*
Present Address + Postal:*
How long at Address:*
If less than 2years please provide previous :
Present Rent:*
Present Landlord:*
Landlord Phone Numbers:*
Reason for moving:*
Your Employer:*
Occupation:*
Monthly income:*
How Long at this position:*
Work Phone:*
Contact Person:*
# 2- applicant name:*
#2-applicant birth date:*
#2- applicant Sin #:*
#2-applicant phone#:*
#2- applicant address:*
#2-How long at address:*
#2- present rent:*
# 2- Landlord:*
#2-Landlords numbers:*
Why are you moving:*
#2-Employer:*
#2-occupation:*
#2-monthly income:*
#2- how long at possition:*
#2-work phone:
#2-contact at work:*
List name and age and relationship of all persons besides yourself that will occupy residents
Name *:*
Name **:*
Name***:*
Make and model of car:*
License plate #:*
Drivers License #:*
Drivers License issued on:*
Drivers licence issued in which province or state:*
Valid License:*
Drivers License expiry Date:*
Have you ever been convicted of a offense:*
Do you have any credit issues:*
If Yes - explain:
Number of adults to occupy Home:*
Number of children under 18 to occupy Home:*
List 2 personal references not related to you include contact numbers
*:*
Emergency contact person:*
Phone number:*
Address:*
Do you have a Pet:*
If yes how many pets:*
Does anyone smoke:*
You may obtain credit information about me by any means be it credit bureaus, my employer or a person in connection with any of my dealings with you and may disclose credit information. You here by verify that all statements on this application are true and authorize verification of all information provided by you.
Date:*
Signature of Applicant:*
Royal LePage Northstar Realty. Property Management . #118- 15272-Croydon Drive Surrey BC V3S-0Z5 604-597-1664. Fax 604-507-2899
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