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224 Lease Agreement
This is a legal binding lease agreement between the "Sober Living Administrator" and the Tenant"
Date *
Date you started at Independence Again, this should only be back dated in cases where adjustments to contract are made and time stamp shall NEVER be modified.
MM
/
DD
/
YYYY
Full Legal Name *
Please include your First Name "Preferred Name if different" Middle Name Last Name
Your answer
Address *
Street address of the Sober Living Home; a new lease will need to be signed upon moving from one facility to another for more than three (3) consecutive days. #1
Room Description *
Room Type, # of roommates, access or amenities #1
Vehicle Fee *
Cost to park a vehicle on property #5
Furnishings *
Items Independence Again will provide and maintain; anything above and beyond this may be required to be provided by the Tenant #7
Rent *
Amount Tenant Paid #11
Your answer
Prorated *
Amount Tenant Paid #12
Your answer
Deposit *
Amount Tenant Paid #13
Your answer
Contribution *
Contributions of Household items. #15
Resident Contact Name *
For any matter relating to this tenancy, the Tenant may be contacted at the Property or through the phone number below. After this tenancy has been terminated, the contact information of the Tenant is:
Your answer
Resident Contact Address *
Resident's Permanent Mailing Address
Your answer
Resident Contact Phone Number *
Resident's Phone Number
Your answer
Credit Card on File *
The credit card you want on file for deposit, weekly rent or other expenditures while living at Independence Again. Enter # or N/A #55
Your answer
Credit Card Expiration Date *
The Expiration date of credit card or N/A #55
Your answer
Security Code *
3 digit code on back of card or N/A #55
Your answer
Name as it appears on the Card *
N/A or By including this information you are affirming you are either the owner of the credit card or an authorized signer of the credit card provided. This constitutes an electronic signature and is legally binding.
Your answer
Date Signed *
Date the contract went into effect
MM
/
DD
/
YYYY
Independence Again Staff *
First and Last name of Independence Again Staff name, credentials if applicable.
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