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: |