Landlord's Name Phone Number Landlord's Address
Address of Facility
Type of Facility
Number/capacity per room, apartment, or house As a condition to the listing of my off campus facility(ies) with Shippensburg University, I hereby acknowledge that I will abide by applicable federal, commonwealth, and township/borough laws regarding the renting of rooms, housings, and apartments.
Print Full Landlord Name Here and Date (This is considered your electronic signature.) Signature Date: ____________________________________________________________________________________________________________________________________________________Optional: Rent Amount Security Deposit Is parking Available? Parking Utilities Renters Pay Gas Electric OilWater Cable InternetNone Change Requested
Note: Each facility should be listed on a separate form.