New Roommates Information Submittal Form:

NEW ROOMMATE INFORMATION SUBMITTAL FORM:

VACANCIES

NEW ROOMMATE INFORMATION SUBMITTAL FORM:

Property:*

Unit Number:*

PERSONAL INFORMATION

First Name*

Last Name*

Cell Phone

Home Phone

Work Phone

Date of Birth

Social Security Number:

Driver’s License Number:

Expiration Date

EMPLOYMENT INFORMATION

Present Employer:

How Long:

Street Address

Address Line 2

City

State

ZIP Code

Position:

EMERGENCY CONTACT INFORMATION

Please list one or more persons for emergency contact, their contact information,and their relationship

Name

Phone

Relationship

The undersigned warrants that the above-stated information is true and correct.

Signature of New Roommate:*

Date*

PLEASE NOTE: ALL NEW ROOMMATE RENT SHALL BE PAID TO THE MASTER TENANT(S) AND OWNER SHALL ONLY ACCEPT RENT AND MAINTENANCE REQUESTS FROM MASTER TENANTS

CONTACT US

(415) 992-8901

(415) 449-3655

info@mbpropertygroup.com

94942, Mill Valley, CA, United States

CA DRE# 01328021

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MB Property Group, Inc.

NEW ROOMMATE INFORMATION SUBMITTAL FORM: