COLUMBUS CAMPER CENTER L.L.C   FAX # 706-507-2195

Applicant Information

Name:

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Current address:

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ZIP Code:

Own    Rent    (Please circle)

Monthly payment or rent:

How long?

Previous address:

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Owned Rented (Please circle)

Monthly payment or rent:

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Employment Information

Current employer:

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Fax:

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Position:

Hourly Salary          (Please circle)

Annual income:

Co-Applicant Information, if for a joint account

Name:

Date of birth:

SSN:

Phone:

Current address:

City:

State:

ZIP Code:

Own    Rent    (Please circle)

Monthly payment or rent:

How long?

Employment Information

Current employer:

Employer address:

How long?

Phone:

E-mail:

Fax:

City:

State:

ZIP Code:

Position:

Hourly Salary          (Please circle)

Annual income:

I authorize Contoso, Ltd. to verify the information provided on this form as to my credit and employment history.

Signature of applicant

Date

Signature of co-applicant, if for joint account

Date