APPLICATION

VACATION RENTAL AGREEMENT


NAME OF APPLICANT:

ADDRESS:

CITY:  STATE:  Zip Code:

HOME PHONE:  CELL PHONE:

E-MAIL:

DRIVER'S LICENSE NUMBER:   LICENSE PLATE NUMBER:



Property: 53722 Pioneertown Road, Pioneertown, CA 92268 The premises are the sole use by the following named person(s) only:

Name #1:
Name #2:
Name #3:
Name #4:
Name #5:

Term: The The term begins at 3PM on and ends at 11AM on .
Rent shall be paid in advance.


Check for stay and a separate deposit check for $200 to be made out to Gay Smith and
mailed to P.O. Box 125, Pioneertown, CA 92268. The security check will not be cashed
and will be returned promptly following your visit and the house has been inspected.
Thank you.


I have read and understand the policies for the rental and agree to them.


Signature: