Number of Adults participating in coalition projects
Number of Adults. Maximum of 6
Number of Adults. Number and Age of Children ………………………………….............
Number of Adults. Number and Age of Children …………………………………................................................. Are any cots required? Y/N (tick as appropriate) Number Required ………………..........……….........
Number of Adults. 2 Number of Children: 0 Your Rental Deposit is due upon signing of Short Term Rental Agreement in the amount of $200.00 Rental rate and fees are as follows: Rental Rate of $120.00 x # night $ State and Local Sales/Rental Tax (16.75%) $Cleaning Fee $150.00$ Rental Deposit $<200.00> Please sign and return the attached lease agreement along with your reservation deposit. The balance of the rental amount is due one (1) days before your arrival date. When the total amount due is received, we will send instructions on how to access the property. All payments are made through SQUARE ( link is on the website) Sincerely, Rose’s House, LLC □ Signed and dated agreement □ Rental deposit □ Balance due □ Keys and access information □ Check-in time: 11AM, unless approved earlier at least 48 hrs. in advance □ Go through inspection checklist □ Review rental rules and regulations □ Check-out time: 2PM, unless approved later at least 48 hrs. in advance □ Go through inspection checklist □ Return keys □ Return security deposit Guest acknowledges that he/she has inspected the Property and unless otherwise noted, everything is in good repair. Any damages upon departure shall be charged to Guest or deducted from the security Deposit.
Number of Adults. Number and Age of Children …………………………………............. Are any cots required? Y/N (tick as appropriate) Number Required ………………………............ Do you require us to book any activities on your behalf? Y/N (tick as appropriate) Do you require airport transfers? Y/N (tick as appropriate) R (payable within one week)) Client Signature: ………………………….....………..... Date: …………………………………...................
Number of Adults. Number of Children under 18: Number of Adults: Number of Children under 18: Number of Children under 18: *With the non-member option, you are agreeing to pay this fee at the time of service in addition to any copays, if necessary. With this option, you will receive Main Care benefits for 7 days after your visit. Anything beyond 7 days after your visit may warrant a follow-up, in-person visit. Primary Doctor: I would like to pay for the year in full at the discounted rate. I, , hereby agree to the terms of the option(s) selected above and detailed in this agreement (reverse side). I authorize Institute of Complementary Medicine, to deduct the cost of that option from the account named herein upon signup, and thereafter on the first (1st) of each month, unless otherwise stipulated in writing. I understand that I may cancel the service at any time with written notice. I understand that this agreement does not replace my insurance and that I am responsible for any copays, co-insurance and deductibles that may apply outside of my membership choice. This monthly fee is not billable to insurance. Institute of Complementary Medicine
Number of Adults. Number of Children under 18: Number of Adults: Number of Children under 18: Number of Children under 18: *With the non-member option, you are agreeing to pay this fee at the time of service in addition to any copays, if necessary. With this option, you will receive Main Care benefits for 7 days after your visit. Anything beyond 7 days after your visit may warrant a follow-up, in-person visit. Primary Doctor: Name on Card: Card #: Expiration: CVV: I would like to pay for the year in full at the discounted rate. I, , hereby agree to the terms of the option(s) selected above and detailed in this agreement (reverse side). I authorize Institute of Complementary Medicine, to deduct the cost of that option from the account named herein upon signup, and thereafter on the first (1st) of each month, unless otherwise stipulated in writing. I understand that I may cancel the service at any time with written notice. I understand that this agreement does not replace my insurance and that I am responsible for any copays, co-insurance and deductibles that may apply outside of my membership choice. This monthly fee is not billable to insurance. Signature Date: Institute of Complementary Medicine
