SPACE # __________

NAME: ______________________________

ADDRESS: ___________________________   CITY: ________________________________

STATE: ________ ZIP CODE: ____________  HOME PHONE: _______________________

E-MAIL: ______________________

DRIVER'S LICENSE: __________________  STATE: ___ EXPIRATION DATE: ________

IDENTIFICATION #: __________________  STATE: ___ EXPIRATION DATE: ________

SOCIAL SECURITY #: ________________  GATE CODE #: ________________________

DATE OF BIRTH: MONTH: ______ DAY: ________  YEAR: _________

EMPLOYER: ____________________________  PHONE #: _________________________

ALTERNATE CONTACT (AT A DIFFERENT ADDRESS)

NAME: ______________________________

ADDRESS: ___________________________   CITY: ________________________________

STATE: ________ ZIP CODE: ____________  HOME PHONE: _______________________

E-MAIL: ______________________

HOW DID YOU HEAR ABOUT HUNTINGTON PARK SELF STORAGE?

_____ TELEPHONE BOOK
_____ LAS PAGINAS AMARILLAS DE PACIFIC BELL
_____ DRIVE BY
_____ FORMER TENANT
_____ TENANT REFERRAL
_____ OTHER REFERRAL

PERSON(S) AUTHORIZED FOR ACCESS:

NAME: _________________________________

NAME: _________________________________

NAME: _________________________________

ALL PERSONS MUST HAVE A VALID I.D OR DRIVER'S LICENSE WHILE ON THE PROPERTY.

TENANT SIGNATURE_________________________  DATE _______________