8218 Turin Rd Rome,

NY 13440 US

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First Name

Last Name

Phone

Address

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City

State

Zip Code

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DOB

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Apartment/Property Name

Property ID

Agent in Charge

Total Duration of Stay

Name of Occupant

Occupation

Are you ready to sign lease?

Have you been convicted of any crime?

Do you own a pet?

Emergency Contact Name

Emergency Contact Address

Address Line 1

Address Line 2

City

State

Zip Code

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Relationship

Purpose of Renting

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