Lodging Application Form

LODGING APPLICATION FORM

RECITALS

WHEREAS, Applicant seeks temporary lodging and related services at the Provider's premises and submits this application for consideration; and

WHEREAS, Provider operates lodging accommodations and will evaluate Applicant's qualifications, references, and authorizations in accordance with Provider's policies and applicable law; and

WHEREAS, submission of this form constitutes Applicant's request and consent to screening, verification, and consideration for acceptance, subject to the terms and conditions set forth below.

APPLICANT INFORMATION

IDENTIFICATION & BACKGROUND

Government ID Type:   Number:

Local Emergency Contact:   Phone:

LODGING REQUEST

Property / Facility Name:

Unit/Room Preference:   Requested Move-in Date:

Length of Stay (estimated):   Number of Occupants:

SCOPE OF LODGING SERVICES

Describe the lodging services, amenities, and any provider obligations (to be completed by Provider or Applicant as applicable):

PAYMENT TERMS

Monthly Lodging Fee: $   Security Deposit: $

Payment Schedule:

Late Fee: — Applicant acknowledges responsibility for timely payment and agrees late fees accrue as stated.

TERM AND TERMINATION

Proposed Term Start Date:   Proposed Term End Date (if applicable):

Either party may terminate the lodging arrangement upon written notice of days unless otherwise agreed in writing or required by applicable law.

CONFIDENTIALITY

Applicant and Provider acknowledge that certain personal and business information exchanged in connection with this application and any resulting lodging arrangement may be confidential. Each party agrees to hold such information in confidence and to use it solely for purposes of evaluating, establishing, or administering the lodging arrangement, except as required by law or necessary to enforce rights under this application or a subsequent agreement.

AUTHORIZATION FOR SCREENING

By checking the consent box and signing below, Applicant authorizes Provider and its agents to obtain consumer reports, background checks, and other verifications necessary to evaluate this application. Applicant further certifies that the information provided is true and complete to the best of Applicant's knowledge. False statements may result in denial of the application or termination of lodging rights.

GOVERNING LAW; ENTIRE AGREEMENT

This application and any acceptance by Provider shall be governed by the laws of the state or jurisdiction where the Property is located, without giving effect to conflict of laws principles. This document constitutes the entire understanding between Applicant and Provider with respect to the matters set forth herein and supersedes any prior oral or written communications, except that additional terms agreed in a subsequent lodging agreement shall govern once executed.

REFERENCES

CERTIFICATION

Applicant certifies under penalty of perjury that the information contained in this application is true, complete, and provided for the purpose of obtaining lodging. Applicant understands that Provider may rely on these statements and that intentional misrepresentation may be grounds for rejection or future termination.

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