RESIDENT INFORMATION FORM

Lot # and Mailing Address

Lot #

Mailing Address (if different from lot #)

Address Line 1

City

State

Zip Code

Owner Residents

Name 1

Email 1

Phone 1

Preferred Method of Contact

Call
Text
Email

Name 2

Email 2

Phone 2

Preferred Method of Contact (copy)

Call
Text
Email

Additional Residents

* Please note that anyone 19 or older MUST have an Application on file with Western Acres.

Name 1

Age 1

Relationship to Owner (1)

Name 2

Age 2

Relationship to Owner (2)

Name 3

Age 3

Relationship to Owner (3)

Emergency Contact

Person not living with you that Western Acres may contact

Contact Name

Contact Phone

Relationship to Resident

Vehicles

Layout 2 2

Vehicle 1 Make

Vehicle 1 Model

Vehicle 1 Year

Vehicle 1 License Plate Number

Vehicle 2 Make

Vehicle 2 Model

Vehicle 2 Year

Vehicle 2 License Plate Number

Vehicle 3 Make

Vehicle 3 Model

Vehicle 3 Year

Vehicle 3 License Plate Number

Vehicle 4 Make

Vehicle 4 Model

Vehicle 4 Year

Vehicle 4 License Plate Number

Pets

Please check all that apply

Dog
Cat
Other

Other Pet:

Pet 1

Pet 1 Name

Pet 1 Weight (Lbs.)

Pet 1 Color(s)

Pet 1 Breed

Pet 2

Pet 2 Name

Pet 2 Weight (Lbs.)

Pet 2 Color(s)

Pet 2 Breed

* Western Acres MUST have a copy of current Vaccines and Rabies Tag # from your vet clinic. Please upload file below.

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