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Maintenance Request
Coedhause Apartments
“Located right across the street from UNC”
Application
Name:
Social Security #:
Date of Birth:
Home Phone #:
Cell Phone #:
Email Address:
Drivers License #:
State of Insurance:
U.S. Citizen:
Yes
No
Current Year in School:
Freshman
Sophomore
Junior
Senior
Applicants Present Address:
Landlord:
Phone #:
Landlords Address:
How long have you lived at present address:
Current Employer:
Employer's Address:
Employer's Phone #:
Monthly Salary:
Position:
Worked there how long:
Additional References, personal or credit
Name
Relationship
Phone Number
Automobile that would park in lot
Make:
Model:
Year:
I understand that if I do not live up to the terms of the lease, or fail to pay rent, this information may be turned over to a credit reporting agency. I represent the information is true to the best of my knowledge. You are hereby authorized to verify my credit and employment references in connection with the processing of this application. I acknowledge receipt of a copy of the application is I wish to have one.
By entering my name below I declare that the foregoing information is true and correct.
Applicant:
Date:
Anti-Spam:
All letters are all UPPER case.
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