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Residential Application Form
When would you like to move in?
Select the type of unit requested?
2 Bedroom
3 Bedroom
4 Bedroom
Centennaire South
Applicant #1
First Name
Last Name
SIN Number
Date of Birth
Address
Address Line 2
City
Province/State
-- Please Select --
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Unknown
Yukon
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Africa, Canada, Europe, Middle East
Armed Forces Americas (except Canada)
Armed Forces Pacific
California
Colorado
Conneticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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
Applicant #2
First Name
Last Name
SIN Number
Date of Birth (mm/dd/yyyy)
Address
Address Line 2
City
Province/State
-- Please Select --
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Unknown
Yukon
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Africa, Canada, Europe, Middle East
Armed Forces Americas (except Canada)
Armed Forces Pacific
California
Colorado
Conneticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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
$
Will there be other occupants?
Yes
No
List Additional Occupants (List name, age and relationship)
Will a pet be occupying the residence with you?
Yes
No
Pet 1 (Specify breed, colour, age)
Pet 2
How did you hear about Southport's residential units?
-- Please Select --
Social Media
Online Advertising
Newspaper/Print Advertising
Word of Mouth
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: