West Park Manor
7225 Highview Road
Port Hardy, BC. V0N 2P0
Telephone # 250-949-1277
 
Applicant: 
Name (print):  Telephone: 
Name (print):  Telephone: 
 
Rental history: 
Current address: 
Date(s) or rental start:  to: 
Landlord's name:  Telephone: 
Reason for leaving: 
 
Previous address: 
Date(s) or rental start:  to: 
Landlord's name:  Telephone: 
Reason for leaving: 
 
Work history: 
Employer / Source of Income:  Telephone: 
 
Name(s) of all others who will occupy premises: 
1:  2: 
 
Vehicle: Make  Model  Year  License plate # 
Vehicle: Make  Model  Year  License plate # 
 
Please note: The applicant(s) acknowledges that pet(s) are not allowed without advance written permission from the landlord. Please note at this time, the building does not accept dogs.
 
Pet(s):  Type: 
 
Person to contact in case of emergency: 
Name:  Telephone:  Relationship: 
 
Person to contact in case of emergency: 
Address applying for:  Apt:  Start date:  Monthly rent: 
 
Co-applicant: 
Name (print):  Telephone: 
 
Rental history: 
Current address: 
Date(s) or rental start:  to: 
Landlord's name:  Telephone: 
Reason for leaving: 
 
Previous address: 
Date(s) or rental start:  to: 
Landlord's name:  Telephone: 
Reason for leaving: 
 
Work history: 
Employer:  Telephone: 
Previous Employer:  Telephone: 
 
Comments: 
 
Please note: The applicant(s) acknowledges that pet(s), barbecues, waterbeds, aquariums, washer/dryers or dishwashers are not allowed without advance written permission from the landlord.