Credit Application Form

4215 DROLET ST.

MONTREAL, QUEBEC, CANADA.

H2W-2L7

LBTSD@AOL.com LoftsInMontreal.com

Leighton Barrett / Affiliated Real Estate Agent

Groupe Sutton --- Centre-Ouest inc.

TEL: 514-845-0190

Date :______________________________

LESSEE : CREDIT INFORMATION

Full Name as appears on Drivers license or Passport :____________________________

Presently residing at : ____________________________________________________

Tel. (Home) :____________________

Tel. (Work) : ______________________

Current Landlord' s Name : _______________________________

Landlords Tel. :_________________________

(Or : if a home owner and residing at same address : yes _____ no_____)

Number of years residing at current address : ______.

Previous Landlords Name :____________________________

Previous Landlords Tel :______________________________

Applicants Birth Date : ______________________________

Drivers License # :

______________________________

State or Province of : ______________________________

Make of Car : ___________________ Year _____________

Registration # :_______________________

SIN : _______________________________

Current Employer : ____________________________

Tel.:

_____________________________

Address : ____________________________________

Occupation : _______________________________

Since : _______________

Renters Principle Bank :

______________________________

Address :

______________________________

Branch # :

______________________________

Bank Acct # :

______________________________

Account Manager Name : ______________________________

Bank Tel. :

______________________________

I the undersigned, declare that all the above information is true and may be verified at any time.

I the undersigned, also authorize Leighton Barrett Realestate Brokes with Groupe Sutton Centre ouest Inc., Montreal, Quebec, Canada) to inquire on:

*My credit history information, with other credit grantors, credit companies, supplier of services, banks, and or mortgage insurers.

*To use my SIN number for the express purpose of obtaining information for credit evaluation.

*To keep this application for our records until the end of a lease.

Signed in ___________________________on ____________________YEAR : _________

Signature : ___________________________

This credit request application needs to be e-mailed to :

leightonbarrett@aol.com