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Mail to: Jennifer Wenner Realty   Or fax to: (706) 549-2507
            170 Snapfinger Dr.
            Athens, GA 30605

Your information will be submitted to Equifax ($25 application fee)

Name  ___________________________________________________
Mailing Address  __________________________________________
Place of Employment  ______________________________________
Previous Address__________________________________________
Date of Birth _____________________________________________
Social Security Number_____________________________________
 

I give my permission for Jennifer Wenner Realty, Inc. to run a credit check on me.

Signature__________________________________Date____________________