Glamis Dunes Storage Customer Form"*" indicates required fieldsStep 1 of 250%Customer InformationQuick Application and Credit Card AuthorizationDate* MM slash DD slash YYYY Move-In Date* MM slash DD slash YYYY Customer Name* First Last Contact Number*Cell Phone#Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Email* Driver's License*Birth Date* MM slash DD slash YYYY How did you hear about us?Vehicle InformationVehicle Make*Vehicle Model*Vehicle Year*Vehicle Plate*Registration Exp*Insurance Company*Policy Exp*Space Size2nd Vehicle *if applicableVehicle YearVehicle PlateRegistration ExpGlamis Dunes Storage – Season Pass (October 2018 – May 2019)Space SizePackage Sand Sports Super ShowSeason SpecialMonths Interested InPayment InformationI hereby authorize Glamis Dunes Storage Inc. to charge my:Charge my card for these many times*and for these many months*For a total charge of*Card Holder Name*Zip Code*Card Number*Expiration Date*CID*Pay by Check: Please fax application and mail hard copy with check enclosed.By separate part this Quick Application becomes a legal and binding document to include all the terms and conditions and covenants of the Rental Agreement. This document is a legal and binding contract by the party whose acceptance hereto is affixed.Agreement Check* By checking this box, I agree to the terms and conditions and agree to this form as a legal binding document.Prove that you are not a robotPhoneThis field is for validation purposes and should be left unchanged.Δ
