Rental Agreement Form

Date of Rental (required)

Type of Activity (required)

Estimated Attendance (required)

Rental Time: Start - End (required)

Checks Payable: Richmond Lenox EMS / Memo: Senior Center Rental

Mail Checks to: Richmond Lenox EMS Attn: Senior Center Rental 34505 32 Mile Road Richmond, MI 48062

Please sign this agreement and return with deposit

I HAVE RECEIVED AND UNDERSTAND THE RENTAL AGREEMENT AND AGREE WITH THE NOTED TERMS AND CONDITIONS.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

I agree to use electronic records and signatures

Phone Number (required)

Alt. Phone Number

Address (required)

City, State, Zip (required)

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