Fill and Sign the Medical History Intake Form Marimed Consults

Submit by Email Print Form Page 1 of 2 Lease Application Landlord: NPTCalgary, a division of 292245 Alberta Ltd. #113, 612 4 Ave NE Calgary AB T2E 0K2, phone 403-294-9357;fax 403-294-9358; Email: Manager@NPTCalgary.com Contacts: Kim Butterfield (Caretaker) cell 403-816-4745 Fred Zinkhofer cell 403-650-8428 Commencement Date: Term: Monthly Rent: Deposit: Premises: 612 4 Ave NE Calgary AB T2E 0K2 Suite # Parking stall # TENANT: CO-TENANT: home: home: cell: cell: work: work: fax: fax: email: email: Name ID(eg SIN#, DL#) Phone numbers Fax and Email Date of birth Vehicles, make, model, license no.; VIN. Previous address Prior landlord, name, phone# Bank reference, name, phone# Employer, name, phone# contact person Tenant Initials_____ Co-Tenant Initials_____ Page 2 of 2 Lease Application Application: Tenant(s) hereby apply to rent the Premises on the terms above, on the Lease Terms, the Usage Rules and the Cleaning and Maintenance Rules all as initialled by Tenant(s) and on any special term as follows: Special Terms, if any: We repeat: There are NO verbal terms. Signature of Tenant(s): Date Signed by Tenant(s): Tenant signs below Co-Tenant signs below ______________________ ____________________________ ______________________________ Signature of Landlord accepting Tenant(s) and giving notice that the name of the Landlord and the postal address and physical location in Alberta for the Landlord are set out at the head of this document. Date signed by Landlord: Landlord signs below ____________________________ The tenancy created by this agreement is governed by the Residential Tenancies Act and if there is a conflict between this agreement and the Act, the Act prevails.