Please complete the entire form. If you have difficulty sending the form, please check to make sure you have answered all required questions in the form.

Contact Information
Contact Information
First Name: A value is required. Last Name: A value is required.
Address: A value is required.
City: A value is required. State/Province: A value is required.
Zip/Postal Code: A value is required. Country: A value is required.

Email: A value is required.
Telephone: A value is required. USA Cell Phone: A value is required.
Emergency Contact: A value is required. Emergency Contact's Phone: A value is required.
Personal Information
Personal Information
Government-Issued Photo Identification:
(country, type of identification and number)
A value is required.
Date of Birth: Please select an item. / Please select an item. / A value is required.
Gender: Male: Female:
Occupation A value is required.
School Attending
(if applicable):
Employer or Internship (if applicable):
Your reason for selecting Old Town Place: A value is required.

While sleeping, I prefer: Complete Silence Quiet Sounds
Moderate Noise Loud Noise
My cleanliness level is: Very Clean Clean Average Messy
Additional needs or preferences:
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Rental Rate & Roommate Preferences
Rental Rate & Roommate Preferences
Click Here For Floor Plans
Apartment 1 | Bedroom A Apartment 3 | Bedroom A
Apartment 1 | Bedroom B Apartment 3 | Bedroom B
Apartment 1 | Bedroom C House | Bedroom A
Apartment 1 | Bedroom D House | Bedroom B
Apartment 2 | Bedroom A House | Bedroom C
Apartment 2 | Bedroom B
 
The Ideal Roommate Mix
No Preference Coed All Male All Female
Total number of roommates:
0 1 2 3
Regarding your request, upon arrival can you be flexible with the first private bedroom we assign to you?
Yes No
NOTE: You may always transfer to the private bedroom or bed size that you prefer. The primary goal is to get you moved in to Old Town Place so that you have a place to live.
Can you be flexible with the first bed size we assign to you?
Yes No
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Rental Period
Rental Period
Preferred move-in date: Please select an item. / Please select an item. / A value is required.
Latest possible move-in date? Please select an item. / Please select an item. / A value is required.

Move-out date
if known:

/ /
Rental Period: Month to Month 1 - 3 Months 3 - 6 Months
6 - 12 Months Over 1 Year
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Rent Payment Information
Rent Payment Information
Source of Income A value is required.
Method of Rent Payment: Personal Check Cash Traveler's Check
Credit / Debit Card (Visa, Master Card, Discover)
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Visitors & Guests
Visitors & Guests
Old Town Place limits the number of guests you may have staying with you to one guest at a time; each guest with a maximum stay of 1 week; not more than 2 guests within a 2-month period. There is a $25.00 Guest Fee that will be charged to you for utility costs. An air-bed and linens will be provided upon request for a Set-up & Laundry Fee of $25.00.
 
Do you have plans for visitors (friends or family) to sleep in your apartment during your stay at Old Town Place? Yes No
If you answered "Yes" to the Visitor question above:
Durring which month, if known?
What is the length of his/her stay?
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Referral Information
Referral Information
How Did You Learn About Old Town Place?
School Hostel International - San Diego
Internship Craigslist.com
Friend Internet search engine (i.e. Google, Yahoo, Ask.com, etc.)
ESLUSA.org Other
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Confirmation Policy
Confirmation Policy
You Must Agree To Move Forward. By Checking this box, you agree to the Confirmation Policy
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NOTE: All required fields must have values in order for this form to be submitted.
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