Official OREA Form 410 Standard

Rental Application

Residential - Revised 2026

John Moncada - Sales Representative

RE/MAX Your Community Realty, Brokerage

1. Property & Occupancy

I/We hereby make application to rent:

Lease Commencing (Date)

Monthly Rental ($)

Other Occupant Name

Relationship

Age

Do you have any pets? (If so, describe)

2. Applicant #1 (Primary)

Full Name Date of Birth Drivers License No. SIN No. (Optional) Occupation Phone Number

Applicant #1 Residence History

Present Address

How Long (From/To)

Current Landlord Name/Phone

Applicant #1 Present Employment

Employer Name Business Address Business Telephone Position Held Name of Supervisor Current Salary Range (Monthly)

3. Applicant #2

Full Name Date of Birth Drivers License No. Occupation Phone Number Email Address

Applicant #2 Present Employment

Employer Name Position Held Name of Supervisor Salary Range (Monthly)

4. Prior Employment (Page 2)

App #1 Prior Employer Length of Employment Supervisor Name

App #2 Prior Employer Length of Employment Supervisor Name

5. Financial Information

Name of Bank & Branch Chequing Account #

Financial Obligations (Monthly Payments To)

6. References & Vehicles

Personal References (Name, Address, Phone)

Automobiles (Make, Model, Year, Licence No.)

The Applicant consents to the collection, use and disclosure of the Applicant’s personal information by the Landlord and/or agent of the Landlord, from time to time, for the purpose of determining the creditworthiness of the Applicant for the leasing, selling or financing of the premises or the real property.

Notice to Applicant:

The Applicant is hereby notified that a consumer report containing credit and/or personal information may be referred to in connection with this rental.

By clicking submit, you represent that all statements above are true and correct.