Fields containing an * are required.
Address of the accommodation *
Desired date
Monthly rent
Number of occupants *
Adult *
Child *
Name of the representative
Is it an assignment of lease? * OuiNon
Name *
First name *
S.I.N.
Birth date *
Driver's licence
Current address *
City *
ZIP code *
Cellphone *
Monthly rent *
Phone
Email address *
Current owner *
Phone *
Extension
Company *
Contact person *
Address
Job *
Annual salary *
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.