Gold Coast Hair and Day Spa

Information may not be reliable

Phone: Cell Phone:
License #: State: Smoke?

Prior Residences (please list the last 4 years):
Address:City: State: Zip:
Owner Name: Owner Phone:
Start Date: End Date:

Employment History (please list the last 4 years)

Supervisor: Supervisor Phone:
Address: City: State: Zip:
Start Date: End Date: Monthly Pay:

Income Source: Amount:
With whom to Verify: Phone:

Name: Relationship: Phone:

Name: Relationship: Phone:

Have you ever been convicted of a crime?
If yes, describe and date each one:

Have you evern been evicted, declared bankruptcy or had a judgement?

I agree to the following three statements:
I represent that the information provided in this application is true, complete and accurate to the best of my knowledge.
I understand that any misrepresentation or omission of information is grounds for eviction.

I understand that the information provided might be used to determine whether to accept this application. I authorize the
Master Tenant to verify all the information given in this application, including past rental information, personal references
andemployment information provided. I authorize the Master Tenant to obtain a current credit and criminal background

I understand that his application is not a rental agreement and that this application does not create any obligation on the