Application

BethelPlace-4095

Applicant 1

Applicant Name*

Date of Birth*

Applicant 2

Applicant Name

Date of Birth

Address:

Apt. No.:

City/Town:

Province:

Postal Code:


Email:


Phone - Home:

Phone - Business:

Phone - Cell:


How soon would like to move in?

*It is your responsibility to contact us annually to update your information.

*It is your responsibility to contact us to indicate a readiness to move. We will begin the pre-admission process when you contact us indicating a readiness to move within 12 months.

Type of Suite Requested*

Do you require parking?*

*Rent for a parking space is extra. Each apartment is allocated one parking space as available.

Please check one of the following for your present form of accommodation*

If renter, name of Landlord

Would you like to apply for a rent geared to income or minimum rent?*

*Bethel Place will require you, to verify your total annual gross income before a lease can be signed. Applicants who expect to pay rent geared to income rent or minimum rent for a 1 bedroom must provide a certified copy of your most recent income tax to calculate the rent formula. Call 1-800-959-8281 to request a copy of your income tax assessment, or visit CRA internet website www.cra.g.ca.

By checking this box, I (We) hereby declare that the information given on this application is correct and/or complete and understand that this application does not constitute an agreement or lease with Bethel Mennonite Care Services, Inc., to provide accommodations.

Bethel Place is committed to protecting your privacy and the confidentiality of your personal information. All information you provide to us shall be kept for the sole purpose of assessing and processing your application for residency.

*It is your responsibility to contact us annually to update your information, including a change in your readiness to move. We will begin the pre-admission process when you contact us indicating a readiness to move within 12 months.