Rent Space

First Name *

Last Name *

Date of Birth *

Last 4 digits of Social Security *

Address 1 *

Address 2

City *

State *

Zipcode *

Email *

Phone Number *

Driver's License *

Driver's License State of Issue *

Alternate Contact Information

Alternate Contact Phone

Alternate Contact Email

Payment Information

Expiration Date *

Security Code *

I have authorized BILL'S SELF STORAGE to automatically debit my bank account or charge my credit card as applicable and requested every month for all charges associated with my storage room. Card holder agrees to notify BILL'S SELF STORAGE of any changes to the banking or credit card information.

Signature *

Date *