Fields containing an * are required.

    Address of the property for rent

    Address of the accommodation *

    Desired date

    Monthly rent

    Number of occupants *

    Adult *

    Child *

    Name of the representative

    Is it an assignment of lease? *
    OuiNon

    Tenant information

    Name *

    First name *

    S.I.N.

    Birth date *

    Driver's licence

    Current address *

    City *

    ZIP code *

    Cellphone *

    Monthly rent *

    Phone

    Email address *

    References

    Current owner *

    Phone *

    Extension

    Employer

    Company *

    Contact person *

    Address

    Phone *

    Job *

    Annual salary *

    Additional information

    Have you ever gone bankrupt?
    OuiNon

    Do you have a record at the housing authority?
    OuiNon

    * To complete your application please upload your ID (ex: driver's license, health insurance card…). Maximum 5mb.

    * I hereby authorize you and your agent to get personal information regarding my creditworthiness or financial situation with the institutions or organizations concerned during and if necessary after the rental period.