GAAP Management Package

2009
Property Management Packet
Aleksandra Peacock
mobile (757) 746-7715
office (757) 333-0862
3024 Edinburgh Drive
Virginia Beach, VA 23452
Gleason & Associates

Gleason & Associates Realty, Inc
3024 Edinburgh Drive
Virginia Beach, VA 23452
(757) 746-7715 Fax (209) 796-7715
gaap@HRRealEstateProperties.com
Dear Prospective Client,
Thank you for contacting us for information regarding our services. Enclosed you will find a copy of our new client
management package which will provide you with information about us and the services we offer.
Gleason & Associates Property Management has specialized in managing residential real estate for over 20 years. We
currently manage single and multi-family, commercial and corporate properties throughout Hampton Roads
Virginia.
As a full service property management company, we offer complete property management services. All of our services
are provided at one low monthly fee with no hidden costs. Each of our licensed Property Managers is knowledgeable,
professional, prompt, and courteous. As experienced real estate professionals, we realize your property is valuable
investment and we treat it as such.
Maximize Your Cash Flow:

We are committed to maximizing your income by obtaining the maximum amount of rent the market will bear.
Minimize the Vacancy Period:
We are committed to minimizing the time that your rental is not is not generating income by designing and executing
a target marketing plan to rent your property as quickly as possible.
Protect Your Investment:
We are committed to protecting your investment by thoroughly screening prospective clients.
Do the Work for You:
We are committed to providing you full service by handling everything on your behalf so you can spend your time on
more important things.
Please review our management package and call us at 757-746-7715 if you have any questions or concerns. We hope
that we can be of service to you and look forward to hearing from you in the near future.
Kind Regards,
Aleksandra Peacock
Gleason & Associates Realty, Inc.
Property Management Division
Visit us on the web at www.HRRealEstateProperties.com

“We Manage...to Make You Money”
Table of Contents
Property Management Services We Provide ...............................................................................................................4
Professional, Prompt, and Courteous Service ..........................................................................................................4
Prepare Your Property to Be Rented .......................................................................................................................4
Determine the Optimal Rental Amount ..................................................................................................................4
Design a Targeted Marketing Program...................................................................................................................4
Thorough Tenant Screening ...................................................................................................................................4
Coordinate Move-In of Tenant ...............................................................................................................................5
Prompt Rental Receipt Collection and Disbursement ..............................................................................................5
Payment of Your Monthly Expenses .......................................................................................................................5
Detailed Monthly Accounting Reports ....................................................................................................................6
Complete Property Maintenance Services...............................................................................................................6
Compare Your Property Management Company........................................................................................................7
Questions That Are Frequently Asked by New Clients ................................................................................................8
Q: What determines the rent for my property? ......................................................................................................8

Q: How are security deposits handled? ...................................................................................................................8
Q: How are tenants selected? .................................................................................................................................8
Q: Do I pay for processing the tenant’s applications? ..............................................................................................8
Q: Who pays for maintenance and repairs to my property? ....................................................................................8
Q: Who pays for the marketing of my property? .....................................................................................................8
Q: Are management and advertising fees tax deductable? .....................................................................................8
Q: What is typically involved in preparing a property to be rented? ........................................................................9
New Client Management Application ...................................................................................................................... 10
New Client Property Information ............................................................................................................................. 14
Home Owners Insurance Verification Form ............................................................................................................. 18
Advertising Options ................................................................................................................................................. 19

Property Management Services We Provide
At Gleason & Associates Property Management, we are committed to fulfilling all of your property management needs. Below is
a list of some of the property management services we provide our clients. If there is a service you are particularly interested in
but cannot find it listed below please call us at (757) 746-7715.
Professional, Prompt, and Courteous Service

 We strive to provide each of our clients and their tenants with professional, prompt, and courteous
service. Each of our licensed Property Managers and staff treats all clients and tenants with respect
and dignity.
Prepare Your Property to Be Rented

 Your Property Manager, Aleksandra Peacock, will meet with you to evaluate your property and make
recommendations to prepare your property to obtain the optimal monthly rental amount.
 Your Property Manager will coordinate the completion of any maintenance or repair items you have
approved using our extensive network of qualified vendors to ensure all work is completed.
Determine the Optimal Rental Amount

 Your Property Manager will do a market analysis to determine the optimal monthly rental amount
for your property utilizing a wide range of professional resources.
Design a Targeted Marketing Program

 Your Property Manager will meet with you to design a targeted marketing program to rent your
property as quickly as possible.
 Your Property Manager will execute your targeted marketing program utilizing the internet, the
Multiple Listings Service, local newspaper, and property signs.
 Your Property Manager will promptly pursue all leads and inquiries and schedule showings of your
property during the week, evenings, and weekends.
Thorough Tenant Screening

 Your Property Manager will thoroughly review each prospective tenant’s rental and credit history,
including prior eviction.
 Your Property Manager will verify your new tenant’s current employment and stated income.

 Your Property Manager will contact your new tenant’s previous landlord(s) to verify payment
history and care of property.
 Your Property Manager will discuss the results of the screening process with you and make our
recommendations.
Coordinate Move-In of Tenant

 Your Property Manager will collect the first month’s rent and security deposit in the form of a
cashier’s check prior to your tenant’s move-in.
 Your Property Manager will prepare all lease agreements utilizing Virginia Realtor’s Association
approved forms.
 Your Property Manager will meet with your new tenant and ensure all agreements have been
properly executed prior to his or her move-in.
 Your Property Manager will have your tenant complete and sign a “Statement of Condition” report
verifying the condition of the property at the time of his or her move-in.
 Your Property Manager will instruct your tenant regarding rental payment terms and required
property maintenance.
Prompt Rental Receipt Collection and Disbursement

 Your Property Manager will promptly collect your rental income from your tenant at the beginning
of each month.
 Our Accounting Department will disburse the rental proceeds in the manner instructed by you on a
monthly basis.
 Your Property Manager will serve three (3) day notices to “Pay Rent or Quit” if rent has not been paid
by the fifth (5th) day of each month.
 Your Property Manager will coordinate the start of unlawful detainer action to evict your tenant in
the event the rent is not paid.
Payment of Your Monthly Expenses

 Our Accounting Department can pay all reoccurring monthly expenses associates with your
property on your behalf:
- Mortgage - Home Owner’s Association Dues
- Property Taxes - Utilities

- Insurance - Gardening and Pool Service
Detailed Monthly Accounting Reports

 Our Accounting Department will provide you with monthly-itemized statements showing income
and expenses related to your property, including year to date totals.
 Our Accounting Department will provide you a year-end accounting summary of your account and
1099s.
Complete Property Maintenance Services

 We provide our clients with 24-hour emergency repair service.
 We minimize the cost of repairs and maintenance using our extensive network of contractors,
vendors, and repair people.
 We coordinate property reconditioning, including painting, window coverings, new carpet, and
carpet cleaning.
 We arrange for any necessary services such as utilities, gardening, and pool service.

Compare Your Property Management Company
How well do you know your property management company? Use the checklist below to compare your current property
management services to what Gleason & Associates Property Management has to offer.
PARTIAL LIST OF SERVICES YOURS OURS
PROMPT RENT COLLECTION √
TENANT SCREENING √
ALL PAYMENTS AND BILLS PAID √
EVICTION AND LEGAL SERVICES √
FREE RENTAL SERVICES TO TENANTS √
PREPARATION OF VACANCIES √
COMPLETE MAINTENANCE SERVICES √
MONTHLY COMPUTERIZED ACCOUNTING √
24-HOUR PAGING SERVICE √
Does your management service stack up? In not, give us a call at (757) 746-7715

Questions That Are Frequently Asked by New Clients
Below are just a few of the questions that are frequently asked by our new clients. If you have questions that are not answered
below, please feel free to contact (757) 746-7715.
Q: What determines the rent for my property?

Ultimately, market demand. We use our marketing skills, analysis, and judgment to optimize rents in accordance with
your goals.
Q: How are security deposits handled?

Security deposits are promptly deposited into the escrow account. They remain in an escrow account until the tenant
vacates the property. By law, all security deposit funds due to tenant must be refunded within thirty (30) days.
Q: How are tenants selected?

We carefully screen each prospective tenant and verify rental history, employment, and obtain a report that
includes credit scores and evictions. The only exceptions are foreign nationals without a Social Security. NATO
military personnel, relocated CEOs and their employees make up a great portion of our tenant community and tend to prefer
direct deposits of their rent reducing the risk of late payments.
Q: Do I pay for processing the tenant’s applications?

No. You pay nothing.
Q: Who pays for maintenance and repairs to my property?

The owner pays for maintenance and repairs, unless the tenant has agreed to assume responsibility. In that case, we
will seek reimbursement on your behalf from the tenant. Because we deal with a large volume of property, we can
normally contract at considerable savings to you for repairs and maintenance. We save you money wherever possible.
Q: Who pays for the marketing of my property?

80% of our properties are rented through our extensive online marketing campaigns and outdoor signs, which is a
free service we provide to you. We pay for the signage and labor cost related to marketing your property for rent
including ad design and layout. The owner pays for the cost of advertising the property for rent in the local periodicals
and the MLS. For more details see the Advertising Options section in the management package starting on page19.
Q: Are management and advertising fees tax deductable?

Generally, as a direct expense item. However, you should confirm this with your tax advisor as your specific situation
might be different. You should only be paying taxes on actual income received.

Q: What is typically involved in preparing a property to be rented?
Generally, you should expect to make the property move-in ready for the tenant. This may involve painting or patch
work, carpet cleaning, and minor repairs. Your property will rent quicker and demand a higher rental value if it is in
excellent condition.

New Client Management Application
CLIENT INFORMATION
LAST NAME FIRST NAME MIDDLE NAME
DATE OF BIRTH DRIVER’S LICENSE NO. STATE SOCIAL SECURITY NUMBER
PRESENT ADDRESS CITY STATE ZIP
HOME PHONE WORK PHONE CELL PHONE EMERGENCY CONTACT
EMAIL ADDRESS
SPOUSE / PARTNER INFORMATION
DATE OF BIRTH DRIVER’S LICENSE NO. STATE SOCIAL SECURITY NUMBER
PRESENT ADDRESS CITY STATE ZIP
HOME PHONE WORK PHONE CELL PHONE EMERGENCY CONTACT
EMAIL ADDRESS
MONTHLY ACCOUNT STATEMENT
Please mail a paper copy of my statement to the following street address:

STREET ADDRESS:
NOTE: If you have an investment partner(s) who requires a separate monthly property statement and is entitled to receive portion of the owner
proceeds, please check this box and fill out a separate form for each partner.
OWNER WITHDRAW OPTIONS
If it is necessary for you to receive your owner proceeds as early as possible, we will make a special effort to do so. However, please understand that we must
receive the rent check(s) and wait a few days to ensure that the tenants check(s) has cleared before we can issue your owner proceeds. We do our best to issue
and mail owner proceeds depending on the needs of individual owners.
If you wish, we can send your owner proceeds directly to your bank (this can save you time and effort).
NO, do not send owner proceeds to my bank. Send them
YES, please send owner proceeds to my bank (fill in the blanks below)
NAME OF YOUR BANK BRANCH OR ADDRESS ROUTING NUMBER ACCOUNT NUMBER
NOTE: If in the future there are any changes in the information in this completed form, please notify Gleason & Associates Property Management in writing as
soon as possible. THANK YOU.

DISBURSEMENT INFORMATION
Gleason & Associates Property Management will pay your reoccurring bills on your behalf. Below is a list of the most common of these bills. Please review each
item and indicate whether you wish to pay the bill yourself or prefer Gleason & Associates Property Management to pay the bill on your behalf.
1. MORTGAGE PAYMENT
Owner will continue to pay himself/herself
Gleason & Associates Property Management will pay on owner’s behalf from funds in the trust account.
PAYMENT ADDRESS
PAYMENT AMOUNT PAYMENT DUE DATE LOAN NUMBER
2. SECOND TRUST DEEDS PAYMENT
PAYMENT ADDRESS
3. PROPERTY TAX PAYMENTS
PAYMENT ADDRESS
$ ________________________________ 1st installment is due on ______________________ 1st installment is late after _______________________.
$ ________________________________ 2nd installment is due on ______________________ 2nd installment is late after _______________________.
4. INSURANCE PREMIUMS
NAME OF AGENCY
PAYMENT ADDRESS
PAYMENT AMOUNT NEXT PREMIUM DATE INSURANCE POLICY NUMBER

5. HOMEOWNER DUES
PAYMENT ADDRESS
PAYMENT AMOUNT PAYMENT DUE DATE ACCOUNT NUMBER
6. GARDEN OR POOL SERVICE
Owner will continue to pay himself/herself Tenant pays.
NAME OF COMPANY/CONTRACTOR
PAYMENT ADDRESS
7. UTILITIES: WATER
NAME OF WATER SUPPLY COMPANY
PAYMENT ADDRESS
8. UTILITIES: ELECTRICITY
PAYMENT ADDRESS
8. UTILITIES: GAS

PAYMENT ADDRESS
10. UTILITIES: TRASH REMOVAL
PAYMENT ADDRESS
11. UTILITIES: TELEPHONE
NAME OF WATER SUPPLY COMPANY TELEPHONE NUMBER
PAYMENT ADDRESS
12. UTILITIES: CABLE
PAYMENT ADDRESS
13. UTILITIES: OTHER
PAYMENT ADDRESS

New Client Property Information
RENTAL PROPERTY INFORMATION
RENTAL ADDRESS CITY STATE ZIP CODE
CROSS STREETS
TYPE Single Family Residence Condo Townhome Duplex Other:
Is this property attached or detached? Attached Detached
How many stories has this unit/home? 1 2 3 Is the unit locates upstairs or downstairs? Upstairs Downstairs
SQUARE FEET YEAR BUILT LOT SIZE SCHOOL DISTRICT
Is the rental located in a gated community? Yes No
GARAGE / PARKING INFORMATION
Is there a garage? Yes No What size is the garage? 1-Car 2-Car 3-Car : 4-Car
Is the garage attached? Yes No Are there any remote openers? Yes No If so, how many?:
TYPE Single Family Residence Condo Townhome Duplex Other:
Is this property attached or detached? Attached Detached
How many stories has this unit/home? 1 2 3 Is the unit located upstairs or downstairs? Upstairs Downstairs
SQUARE FEET YEAR BUILT LOT SIZE SCHOOL DISTRICT
Is the rental located in a gated community? Yes No
ROOMS
BEDROOMS 1 2 3 4 5 LIVING ROOM Yes No KITCHEN ROOM Yes No
TOTAL BATHS 1 2 3 4 FULL BATHS: ______ ¾ BATHS: ______ ½ BATHS: ______ ¼ BATHS: ______
DINING INFO: Dining Room Formal dining Room Kitchen/Dining Combo Breakfast Nook Counter/Bar
ADDITIONAL ROOMS: Family Room Den Bonus Room Great Room Office Loft
Check all that apply. Sitting Room Sunroom Sunroom Other: _________________________________________________________
KITCHEN
KITCHEN ONFO: Refrigerator Dishwasher Range Oven Is the rangegas or electric? Gas Electric
Check all that apply. Microwave Garbage Disposal Island Trashcompactor Granite Countertop
Who is responsible for maintaining the kitchen appliances? Owner Tenant
Additional kitchen information: _______________________________________________________________________________________________________

OUTDOOR AREA
Pleas indicate what type of outdoor are your property has:
Backyard Patio Balcony
Is the backyard fenced? Yes No Is the patio covered? Yes No
AMENETIES
FIREPLACE: Yes No TYPE: Gas Electric Wood Burning LOCATION: ______________________________
WASH & DRYER HOOKUPS: Yes No LOCATION: ______________________________ TYPE: Gas Electric
WASHER & DRYER IN UNIT: Yes No Who is responsible for maintaining the washer/dryer? Owner Tenant
Is there a community laundry room? Yes No
SWIMMING POOL: Yes No Is this a private pool located at the single-family residence? Yes No
SPA / JACUZZI : Yes No Is this a private spa / jacuzzi located at the single residence? Yes No
ADDITIONAL AMENETIES: Tennis Court Club House Fitness Center Gym Beach Private Beach Access
Golf Course Laundry Facilities Business Center Playground Lake River
FLOORING
Check all that apply: Carpet Location: ________________________________________________________________________________
Vinyl Tile Location: ________________________________________________________________________________
Wood Location: ________________________________________________________________________________
Laminate Location: ________________________________________________________________________________
Ceramic Tile Location: ________________________________________________________________________________
Other Location: ________________________________________________________________________________
COOLING / HEATING
COOLING: Central Wall Unit Other: _________________________________________________
HEATING: Central Forced Air Wall Unit Base Board Heating Other: _________________________________
Does the home have any ceiling fans? Yes No If so, how many? _______________________

LEASING INFORMATION
Is the property currently available for lease? YES NO
Is the poperty currently under contract with another leasing company? YES NO
Do you want to Gleason & Associates Poperty Management to manage your property? YES NO
If so, what do you want the lease terms to be? 36 months 24 month 12 months 6 months 3 months month-to-month
Do you want your property to be listed in the local Multiple Listings Services? Yes No At a later date: ______________________________
What date is the porperty available for showing? DATE: ____ / ____ / _______ Is smoking allowed? Yes No
What date is the property available for move-in? DATE: ____ / ____ / _______
MONTHLY RENT: $ ___________________ SECURITY DEPOSIT: $ ___________________ PET DEPOSIT: $ ___________________
Are any pets allowed? Yes No What type of pet is allowed? Cat Dog How many are allowed? ________________
What size of dog is allowed? any dog medium dog small dog Must the dog remain outdoors? YES NO
Additional pet info:
Property Description
Please use the area below to highlight any special features or details of your property. This description will be of help tp us advertising your property when it is
available for rent.
__________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
Special Instructions
Please use the area below to tell us about anything you feel might be of importance, so that we will be able to better manage your property
__________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
For Gleason & Associates Property Management Internal Use Only
SHOWING INFORMATION
Poperty manager, please fill out the showing information below.
Is the property curretnly vacant? YES NO
What day is the property available for showing? DATE: ____ / ____ / ________
What day is the property available for move-in? DATE: ____ / ____ / ________
SHOWING INSTRUCTIONS:
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
DRIVING DIRECTIONS:
_________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________

Home Owners Insurance Verification Form
Dear Owner, Dated: ____________________________
It is a requirement of our company that our property owners name Gleason & Associates Realty as an additional insured party
on your Liability insurance policy.
 $300,000.00 for Condo or Apartment
 $500,000.00 for Single Family Residence
 $1,000,000.00 for a Single Family Residence with a pool or spa.
Please complete this form and return it with the management package.
SUBJECT PROPERTY __________________________________________________________________________________

__________________________________________________________________________________
OWNER(S) _________________________________ _______________________________

Print Name Print Name
_________________________________ _______________________________
Signature Signature
MY INSURANCE INFORMATION
_________________________________ _______________________________
Name of Insurance Company Street Address or P.O. Box
_________________________________ _______________________________
Name of Agent City, State and Zip
_________________________________ _______________________________
Policy Number Phone Number
_________________________________ _______________________________
Extent of Liability Coverage Fax Number
Gleason & Associates Realty, Inc. wants to thank you for your cooperation.

Advertising Options
Our property manager, Aleksandra Peacock, will meet with you to design a specialized marketing plan to rent your property
quickly. We offer various online and print advertising options for you to choose. Below and on the following pages are the
descriptions of some of the option and their estimated cost. These advertising are subject to change periodically as our marginal
cost increases or decreases.
1 ONLINE PACKAGE FEE

I. www.HamptonRoadsRealEstatePoperties.com Free
Neighborhood based search, intuitive design, and rich listing content made available by our website is a
successful and growing source of renter leads.
II. www.Craigslist.com Free
We will create and post a detailed listing with up to four (4)
III. Audio Description Free
We will record and provide an audio description of your property online that visitors will be able to
listen to at their convenience.
IV. Photographs Free
We will take and post up to 36 pictures of you property.
V. Virtual Tour Free
Your property will be viewable as a virtual tour to visitors.
VI. Downloadable Brochure Free
We will create brochure that prospective tenants can download, save, forward, and print at their
convenience.
VII. Syndication Free
We will create and post your property on:

2 MLS PACKAGE FEE
I. Multiple Listings Service $200
A full Multiple Listings Service ad will be posted where licensed agents will participate in bringing a
tenant for a commission of _______ % of the annual/monthly rent or a flat fee of $200 and up. Your
listing will also be posted on Realtor.com’s For Rent section.
CLIENT INFORMATION
PRESENT PROPERTY ADDRESS CITY STATE ZIP
RENTAL PROPERTY ADDRESS CITY STATE ZIP
HOME PHONE WORK PHONE CELL PHONE
EMAIL ADDRESS
ONLINE PACKAGE
NO, I do not want the Online Package advertising option.
YES, I do not want the Online Package advertising option.
NO, I do not want the MLS Package advertising option.
YES, I do not want the MLS Package advertising option.
I would like to provide a ___________ % of the monthly/annual rent.
I would like to provide a flat fee of $ _________________.
CLIENT SIGNATURE PRINT NAME DATE


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2009

Property Management Packet

office (757) 333-0862

3024 Edinburgh Drive

Virginia Beach, VA 23452

Gleason & Associates

Dear Prospective Client,

Maximize Your Cash Flow:

Visit us on the web at www.HRRealEstateProperties.com

Professional, Prompt, and Courteous Service ..........................................................................................................4

Prepare Your Property to Be Rented .......................................................................................................................4

Determine the Optimal Rental Amount ..................................................................................................................4

Design a Targeted Marketing Program...................................................................................................................4

Thorough Tenant Screening ...................................................................................................................................4

Coordinate Move-In of Tenant ...............................................................................................................................5

Prompt Rental Receipt Collection and Disbursement ..............................................................................................5

Payment of Your Monthly Expenses .......................................................................................................................5

Detailed Monthly Accounting Reports ....................................................................................................................6

Complete Property Maintenance Services...............................................................................................................6

Compare Your Property Management Company........................................................................................................7

Questions That Are Frequently Asked by New Clients ................................................................................................8

Q: What determines the rent for my property? ......................................................................................................8

New Client Management Application ...................................................................................................................... 10

New Client Property Information ............................................................................................................................. 14

Home Owners Insurance Verification Form ............................................................................................................. 18

Advertising Options ................................................................................................................................................. 19

Visit us on the web at www.HRRealEstateProperties.com

Professional, Prompt, and Courteous Service

Prepare Your Property to Be Rented

Determine the Optimal Rental Amount

Design a Targeted Marketing Program

Thorough Tenant Screening

Visit us on the web at www.HRRealEstateProperties.com

Coordinate Move-In of Tenant

Prompt Rental Receipt Collection and Disbursement

Payment of Your Monthly Expenses

- Mortgage - Home Owner’s Association Dues

- Property Taxes - Utilities

Visit us on the web at www.HRRealEstateProperties.com

Detailed Monthly Accounting Reports

Complete Property Maintenance Services

Visit us on the web at www.HRRealEstateProperties.com

PARTIAL LIST OF SERVICES YOURS OURS

PROMPT RENT COLLECTION √

ALL PAYMENTS AND BILLS PAID √

EVICTION AND LEGAL SERVICES √

FREE RENTAL SERVICES TO TENANTS √

COMPLETE MAINTENANCE SERVICES √

MONTHLY COMPUTERIZED ACCOUNTING √

24-HOUR PAGING SERVICE √

Visit us on the web at www.HRRealEstateProperties.com

Q: What determines the rent for my property?

Q: How are security deposits handled?

Q: How are tenants selected?

Q: Do I pay for processing the tenant’s applications?

Q: Who pays for maintenance and repairs to my property?

Q: Who pays for the marketing of my property?

Q: Are management and advertising fees tax deductable?

Visit us on the web at www.HRRealEstateProperties.com

Visit us on the web at www.HRRealEstateProperties.com

LAST NAME FIRST NAME MIDDLE NAME

DATE OF BIRTH DRIVER’S LICENSE NO. STATE SOCIAL SECURITY NUMBER

PRESENT ADDRESS CITY STATE ZIP

HOME PHONE WORK PHONE CELL PHONE EMERGENCY CONTACT