First Name             Last Name                    MI

Street Address

City                                 State                               Zip

Home Phone              Cell Phone

Email

Auto Make:   Auto Model:  Year:

Auto Tag #:   Tag State   Driver's License #:

the undersigned agrees to the limit of people in your party, to be responsible for any and all damages caused to the premises during the rental period described below and agrees to leave the premises in satisfactory condition at check-out time.  the undersigned acknowledges that the outdoor activities and amenities offered by the rental of said home and property-Santa Fe on the Cartecay River may entail some risk or injury and the undersigned assumes such risk.

Check-In Date:  (3:00 p.m.)     Check-Out Date:   (11:00 a.m.)

Signature (Type name):       

please, no pets or smoking allowed.

Rental amount is $135.00 per night for 2 guests, $15.00 per person, per night for extra guests and children under 12, no charge.  2 night min./3 night min. on holidays.  Please return this sheet with $150.00 security deposit, made payable to Telia Miller and return to the address BELOW, within 7 business days.  Please list names of all guests: 

Guest 1:  Guest 2: Guest 3:

Guest 4:  Guest 5:  Guest 6:

Guest 7:  Guest 8:  Guest 9:

Comments: