DOCF Facility Rental Application 2019

DELTAS OF CHARLOTTE FOUNDATION
Application Information
Name

First NameLast Name
Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
Email
Event Date

MonthDayYear
Event Start Time
Type of Event
Event End Time
Are you Having/ Serving Alcohol?

YesNo
Are you Having Catered Food/ Meal?

YesNo
Are you a Non-profit Organization?

YesNo
Form Attached
Is security required/ needed?

YesNo
Security - Minimum of 3 hours @ $35 per hour
Deposit
Amount
Space
PayPal
Check
Do you need an AV?

YesNo
Podium
Deposit Refund Requested On
Less/ Full Reason
Rental Fee
Amount
Date Paid

MonthDayYear
Amount
Date Paid

MonthDayYear
Amount
Date

MonthDayYear
Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information in my application or infraction(s) of contract may result in loss of deposit.
Signature
Date

MonthDayYear
Should be Empty: