HOUSING APPLICATION DONATE Please fill out all fields that are applicable and submit to us. HOME APPLICATION Applicants Name Phone Number Date of Birth Email Are you applying for a particular home or location? If so please specify Marital Status Marital Status Married Common-Law Divorced Single Separated Widowed List all current household members names, age, and sex. Current Address, province, postal code Number of years at current address If you own your residence what is your monthly Mortgage payment per month? Do you own any other real estate? Do you own any other real estate? Yes no If you rent what is your rent payment? *Please supply a copy of your lease OR recent receipt Or cancelled rent Cheque Landlords Name? Landlord's Full Address Landlords Phone Number Co-Applicants Name (if applicable) Phone Number Date of Birth Marital Status Marital Status Married Common-Law Divorced Single Separated Widowed Current Address, province, postal code Number of years at address Please Check other rooms that you have in your current dwelling. Please Check other rooms that you have in your current dwelling. Kitchen Bathroom Living Room Dining Room Basement Other Please describe other room If you rent what is your monthly payment?* Please describe the condition of the dwelling you currently live in. How is your current house situation not meeting your needs? Are there special needs that you would consider in choosing or building a house - i.e. accessibility, room for grandparents etc. ? Are there special needs that you would consider in choosing or building a house - i.e. accessibility, room for grandparents etc. ? yes No If yes please indicate needs Are you currently employed? Are you currently employed? Yes No Name of applicants current employer Address of current employer Phone Number of current employer Your Position Title Part-time hours per week Full-time hours per week Years at current job Name of previous employer Previous employers address Previous employer address Previous position title Part-time hours pers week Previous full-time hours per week 9 + 8 = SUBMIT! Name Email Address Message Send Message Visit us on FACEBOOK! Don't forget to check out our DAILY DEALS! 1-506-462-4881 800 St Mary's Street Fredericton Mon-Sat 9:00 AM - 5:00 PM