Rental application

The 59 · 59 3rd Street NW · Portage la Prairie, MB

(204) 856 3914
info@the59.ca

How to apply: print this form (or save it as a PDF and fill it digitally), complete all sections, and return it to us by email or in person. One form per adult applicant is preferred for credit and reference checks.

Suite & move-in

Suite applying for (if known)

Desired move-in date

Date of application

Applicant

Full legal name

Date of birth

Phone

Current residence

Current address

Monthly rent

Landlord / property manager

Landlord phone

How long at this address

Reason for leaving

Employment & income

Employer

Position

Length of employment

Work phone

Gross monthly income

Other income (source / amount)

Household

All other occupants — names & ages (including co-applicant and children)

Pets

NoneYes — type / breed / size:

Smoking household? (The 59 is smoke-free)

NoYes

Vehicle 1 — make / model / plate

Vehicle 2 — make / model / plate

References (not family)

Reference 1 — name

Relationship

Phone

Reference 2 — name

Relationship

Phone

Consent & signature

Applicant signature

Date

The 59 · 59 3rd Street NW, Portage la Prairie, MB

the59.ca · (204) 856 3914