LESSEE INFORMATION

Last Name: First Name:   Middle Initial:   Mr. Mrs. Ms.

Address:    City State:   Zip:

Email Address:

Phone: Home Cell Fax

Employer: Phone: Work

Birthdate: Month Day Year       

Driver's License Number: State: Expires: (Month, Day, Year)

Social Security Number (or last 4 digits):


SPOUSE OR ALTERNATIVE ACCESS INFORMATION

Relationship to Lessee: Select One Spouse Child Parent Sibling Other None ... Other - Please state relationship:

Last Name: First Name:    Middle Initial:

Phone: Day Evening


EMERGENCY CONTACT INFORMATION

Relationship to Lessee:  . Select One Spouse Child Parent Sibling Other None

Last Name:   First Name:   Middle Initial:

Phone: Day Evening


UNIT INFORMATION

Reserve Unit: Yes No ..........Size of Unit Needed: 5x10 10x10 10x10 cc 10x15 10x15 cc 10x20 10x20 cc 10x30 10x30 cc   (cc=climate control)

Term of Lease Desired: Select One 1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months

Expected Arrival Date: Month Day Year

Enter Your Preferred Facility Access Code (must be at least 5 numbers or more):

Existing Account: Yes  ..........Unit or Account Number (Existing accounts only):
 

COMMENTS: