Send with application
Application Fee$ 25.00
Administration fee$ 25.00
Security Deposit (refundable)$100.00

Name: __________________________________________________________

Address: _______________________________________________________

City: __________________________________________________________

State: _________________________________________________________

Country: _______________________________________________________

Postal/Zip Code: _________________________________________________

E-Mail: ________________________________________________________

Phone: _________________________________________________________

SSI #: ________________________________________________________

Birth Date: ____________________Sex: __________

DL #: __________________________________________________________

Desired Move-in Date: __________________________________________

Length of stay: _______________________________________________

Apt.or Floor request ___________________________________________

Roommate Request: ______________________________________________

Private or Shared: _____________________________________________

Reference 1: (Employer or Landlord)
Name: ________________________________________________________

Phone: ________________________________________________________

Relationship: ________________________________________________

Reference 2: (Employer or Landlord)
Name: _________________________________________________________

Phone: ________________________________________________________

Relationship: __________________________________________________

I do hereby authorize a Collegiate Inn Representative and consumer credit reporting agency to investigate my credit and financial history, character, general reputation, and to inquire of and check with the persons and references named herein. I further authorize such credit or consumer reporting agency to make a report in connection therewith.

Mail this application with the security deposit and applicable fees and a contract will be mailed to you upon acceptance of your application.

Signature____________________________________________________

Additional Information: ______________________________________

______________________________________________________________