Personal Contact Information |
| Your Name: |
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| Home Address: |
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| City: |
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| State: |
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| ZIP: |
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| Home phone: |
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| Cell phone: |
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| Email: |
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Business Contact Information |
| Business name: |
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| Type (Choose one): |
Corporation
Sole proprietor
Partnership
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| Nature of business: |
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| Years in business: |
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| Number of employees: |
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| Vehicles: |
Number of vehicles/large equipment to be based at Bunn's Village: |
Business References |
Reference 1 |
Company Name:
Contact:
Phone:
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| Reference 2 |
Company Name:
Contact:
Phone:
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| Reference 3 |
Company Name:
Contact:
Phone:
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Insurance Information |
| Liability Limits: |
One injury one person: required $500,000
One accident: required $1,000,000
Property damage: required $1,000,000
Insurance and proof of insurance are required. |
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Insurance Company (not agent):Phone: |
Building Info |
| Desired unit: |
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| Desired Lease: |
1 year
2 years
3 years
5 years
Other:
Option to renew at end of lease
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Questions or Comments |
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| Security: |
Please type the numbers and letters you see to the
left: |