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Mail to: Jennifer Wenner Realty   Or fax to: (706) 549-2507
            102 Barrington Dr., #1.
            Athens, GA 30605

Your information will be submitted to the Athens, GA Credit Bureau

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____________________