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Complete and submit the form below, or complete, print and mail to the address below.

Ed Balcerzak
143-C Newport Bay Drive
Ocean City, MD 21842
FAX 410-524-8776
Applicant's Information
Applicant's Name:
Applicant's Address:
Applicant's City, State, Zip:
Applicant's Home Phone:
Applicant's Cell Phone:
Applicant's Email:
Applicant's School:
Applicant's School Phone:
Applicant's Parent's Information
Mother's Name:
Mother's Address:
Mother's City, State, Zip:
Mother's Home Phone:
Father's Name:
Father's Address:
Father's City, State, Zip:
Father's Home Phone:
Unit Information
Address and Street of Apartment
you are applying for:
Unit Number:
Tell us the approximate
dates of your stay.
Arrival Date:
Departure Date:
Group Leader Information
"Group Leader" is the individual who will be responsible for collecting
and paying of all rents and deposits.
Group Leader's Name:
Group Leader's Address:
Group Leader's City, State, Zip:
Group Leader's Home Phone:
Group Leader's Cell Phone:
Roommate Information
Please list all roomates that will be living at the property.
Roommate #1:
Roommate #2:
Roommate #3:
Roommate #4:
Roommate #5:
Roommate #6:
Roommate #7:
Roommate #8:
Comments/Other


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143-C Newport Bay Drive / Ocean City, MD 21842 / PHONE 410-524-7705 / CELL 443-497-4746 / FAX 410-524-8776 / opsales@comcast.net

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