Online Residential Lease Pre-Application 3208 Hwy 33 at 32nd Street La Crosse, WI 54601 PERSONAL INFORMATION Name (required): Daytime Phone (required): Email (required): Permanent Address (required): City (required): State (required): Zip (required): PERSONAL REPRESENTATIVE CONTACT INFORMATION Personal Representative: Relationship: Phone: Address: City: State: Zip: LEASEE/PAYMENT RESPONSIBILITY Check one (required): Personal lease - If accepted, I will personally be responsible for lease payments.Corporate/Third Party CORPORATE/THIRD PARTY CONTACT INFORMATION Agency responsible for lease payments: Contact: Position: Company: Unit/Department: Other: Address: City: State: Zip: Phone: Email: Web: LIVING PREFERENCES What is the nature of your temporary relocation? What requirements do you have in regard to your temporary stay? Vehicle #1 (required): Vehicle #2: RENTAL INFORMATION Lease length? 3 months6 months9 monthsOther What is your anticipated date of occupancy? What is your anticipated date of departure? SUMMARY OF LEASE CONDITIONS - Lease rate: $1075/Mo - Security deposit ($1075) required to hold unit - Monthly payments due on/before the 5th each month by automatic deposit - Minimum lease 3 months - No partial month lease - Utilities included -- allowances apply - No pets/smoking in/on premises - Lease and non-standard lease addendum approvals required - Residence policies reviewed - Security deposit… -- Not to be used as rent -- Subject to deductions required to return unit to original condition -- Returned by mail within 10 days following departure PERSONAL STATEMENT/COMMENTS: APPLICATION SIGNATURE I/We hereby give permission for appropriate information to be released for reference purposes. Includes corporate verification and assurance of lease payment. Check box to accept (required) If there is a second adult occupant, please complete have them submit a separate form and include their name here: