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All fields are required unless otherwise noted

Which property is this for?
	Campus Pointe

Applicant Name
Applicant Address
City
State
Zip/Postal Code
Current Phone Number
E-mail Address
New Apartment Number if Known (optional field)
Credit Card Type	Mastercard Visa
Credit Card Number
Name on Card
Billing Address
City
State
Zip/Postal Code
	Check here if this is an international address
Cardholder e-mail address
Expiration Date	Select One 01 [January] 02 [February] 03 [March] 04 [April] 05 [May] 06 [June] 07 [July] 08 [August] 09 [September] 10 [October] 11 [November] 12 [December] Select One 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Amount to Charge	($99, Limited Time Special!)
	Upon clicking "Submit," You will be given a chance to confirm/cancel your transaction before your card is actually billed.