ISLAND VILLAGE CONDOMINIUM ASSN, INC.

RENTER’S PROFILE

2135 North Courtenay Pkwy., Merritt Island, FL 32953

Your cooperation in completing this profile thoroughly and promptly will be greatly appreciated. Please return completed profile to the above address or fax to 321-799-0630. *We do supply owners with a directory of other residents, so if you wish to be unlisted, please check the box below.

1. UNIT # _________________

2. UNIT OWNER'S NAME: _______________________________________________________

3. Tenant’s Full Name(s): _________________________________________________________

4. Address for Receiving Mail: _____________________________________________________

5. Telephone Numbers: I wish for my condo phone number to be unlisted. *Check here: [ ]

Condo: (321) ______________________ Other Residence: ( ) ______________________

Work: ( ) ______________________ Company Name: ____________________________

6. E-Mail Address: _____________________________________________ [ ] Check if “None”

7. Emergency Contact: ____________________________ Phone: ( ) ____________________

8. Rental Information: Handled by Owner? YES _______ NO _______

9. IF NO, please provide name & phone number of agent or person handling rental:

Name: ______________________________________ Phone: ( ) _____________________

10. Number of Persons in Unit:_______________ Lease Term: _______________ months

Names of Others Living in Unit: ___________________________________________________

11. Please attach copy of lease and make sure tenant understands where to park and has copy of rules

and regulations.

12. PETS: (Up to 2 indoor animals only – cats, small birds)

Type: ____________________ Name: _________________ Weight: ____________

13. VEHICLE / BOAT REGISTRATION:

Year Make Model Color Tag# State

______ ___________ _______________ ________ _______________ _____