Velika Realty Inc.

Unit Transfer Request

Contact Information

First Name:

Last Name:

Current Address & Unit #:

Phone Number:

Email:

Household Composition

List yourself (primary tenant) on Line 1, and then list all other people in your household who will be living with you.

Full Name	Age	Gender	Relationship to Tenant	Type of Disability (if any)

Do you have any household pets?

Yes No

If Yes, please specify the type of pet you have:

Transfer Reason

Please indicate your transfer reason by selecting one of the following:

Medical Need Distance to Work or School Social Conflict
Inappropriate Unit Size Other, please specify:

Preferred Transfer Location


Address:
Preferred Square Footage of the Unit:
Preferred Number of Bedrooms:
Preferred Number of Bathrooms:
Preferred Moving In Date:

Please provide additional information on your need to transfer, including if you have any special requirements that should be taken in consideration. (Ex. Wheelchair accessible, no stairs…):