Belmead Co-op

/ Set up interview
9024-182 Street
Edmonton, Alberta
T5T 2E3
(780) 487-4123

Application for Membership

Name: ______

Phone Number: ______

Address: ______

How did you hear about BHC? (if from someone in the co-op, please identify)
Why do you want to move into a Co-op?
In what way could you contribute to the Co-op?

ALL INFORMATION IS KEPT CONFIDENTIAL. IF YOU ARE AWARE OF ANY CREDIT PROBLEMS, PLEASE PROVIDE INFORMATION THAT MAY HELP THE CO-OP GET AN ACCURATE PICTURE OF YOUR HISTORY. PLEASE PUT A "C" BESIDE ANY INFORMATION THAT YOU WISH TO BE KEPT CONFIDENTIAL. CONFIDENTIAL INFORMATION SHALL ONLY BE USED BY THE BOARD OF DIRECTORS AND KEY COMMITTEE MEMBERS.

A $16.00 APPLICATION FEE IS PAYABLE AT TIME OF INTERVIEW. THIS WILL COVER THE COST OF A CREDIT CHECK AND IS NON-REFUNDABLE ONCE YOU HAVE BEEN INTERVIEWED. ONLY ONE APPLICATION FEE IS CHARGED PER HOUSEHOLD.

DROP COMPLETED APPLICATION IN MAILBOX AT 9024-182 Street

YOU WILL BE CONTACTED TO ATTEND AN INTERVIEW

Belmead Co-op

/ Credit Check + References
APPLICANT NAME / CO-APPLICANT NAME
ADDRESS / ADDRESS
DATE OF BIRTH/AGE / DATE OF BIRTH/AGE
S.I.N. / S.I.N.
BANK / BRANCH / BANK/BRANCH
OCCUPATION / OCCUPATION
EMPLOYER / EMPLOYER
PHONE NUMBER / PHONE NUMBER
LANDLORD / LANDLORD
LANDLORD’S ADDRESS / LANDLORD’S ADDRESS
LANDLORD’S TELEPHONE NUMBER(S) / LANDLORD’S TELEPHONE NUMBER(S)

Alberta legislation – the Personal Information Protection Act (PIPA) – came into force on January 1, 2004. Under this legislation, we must obtain your consent to use the information supplied on the attached application, which will be used to ascertain your qualifications for membership.

This information may or may not be used for the following purposes:

·  Verify your place of employment; this may include asking about your future with your employer

·  Credit check – we ask NACHA (Northern Alberta Cooperative Housing Association) to do our credit checks for a fee of $16.00

·  Landlord reference – we may/may not contact your previous landlord for information

·  Internal contacts – should you list a member as a reference, they will be contacted for information

·  Any further contacts deemed necessary to arrive at a decision on your qualification for membership

Belmead Housing Co-operative (BHC) will use this information only for the reasons listed, and maintain your application in your membership file if you are accepted for membership. Otherwise, applications will be destroyed after a “to be determined” period of time.

I/We declare that all the information in the attached application is correct and true, and hereby authorize BHC to verify any and/or all of the information contained herein, and to perform a credit, bank and landlord check at the discretion of the Membership Committee or Board of Directors.

(All prospective adult residents must sign)

______

Name Date

______

Name Date

______

Name Date

Please use the other side for further signatures or information

Belmead Co-op

/ Subsidy Committee

History:

Name(s)
Gross Income per Month
Gross Income per Year
Monthly Rent
Utilities (estimate)
Children – Name + Age

NOTE: All new members are initially assigned to either the Membership or Maintenance Committees, and may apply to other committees when an opening is available

Will your unit have a pet(s)? Yes [ ] No [ ] Type: ______

Number/Type of vehicles ______

Thank you for applying. You will be contacted for an interview.

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