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Imagique Salon Suites

               Leasing Application

Personal Information

Last name :   First name :


Address :

City : Zip :

Email :

Mobile Telephone :

Professional License Number :

Renewal Date :

Type of License Name of :

Work History

Present Salon Name

Date Worked From :   To :

Zip :

Are you on salary, commission or rental?

Other Infornmation

Imagique location Applying For :

Desired Suite Number :

Desired Date of Occupancy :

How did you hear about Imagique?

In the past seven years

Have you been disciplined by any State or Local Agency?

Have you been convicted of or plead guilty to any criminal or felony offense?

Are you presently charged with any felony violations of law?

Have you ever been evicted for any reason from a Landlord?

Have you ever broken a Lease Agreement?

If your answer is YES to any of the preceding questions or any part of the questions, please provide the detail below to include the date, place and nature of each such conviction(s) or pending charge(s). (The existence of a conviction or pending charge will not necessarily preclude you from leasing or employment. The nature of the crime and its relationship to the lease or position applied for, the degree of rehabilitation and the time elapsed since the crime or release from confinement will all be considered.)

Explain :

PERSONAL REFERENCES (aside from family members)

Name : Address : Phone :

Name : Address : Phone :


Name : Address : Phone :

Name : Address : Phone :

Social Security Number : Drivers License Number :

Date of Birth :

Security Code
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