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: