Unit _________________________

Valdez, Alaska

How you heard about us.  Do we have anyone to thank?

     Room(s) selected  _____________________________________________

Beginning         _______________ Estimated arrival time _________________

    Ending              _______________ Estimated time of departure _________

Price                _______________   Make checks out to Hursh Realtors Trust

How paid           ________________    Check, Visa, MC, cash or TC         

Credit card number also required in lieu of deposit or with payment by cash or check

Visa or Master Card     _____   ______   ______   ______    Expires ____  ____

Thank you for not smoking inside

Thank you for not bringing pets

Kitchen use is available for everyone if cleaned up afterwards,

Otherwise an additional fee of $25 shall be authorized on credit card

Extensive kitchen use available when no other discounts have been taken; or with extra fee.

Rental rate includes _____ full kitchen use

OR , Rental Rate excludes ______ full kitchen use (sleeping/bath only)

Please note, that if non-resident guests have day use of unit,

Add on fee per person shall be $15/day

Please list the names of all approved people who will be occupying this unit.

Phone at this location _________________

TV included    ___________________

Terms above accepted and home, room & bath found to be satisfactory prior to spending the night.

Name ___________________________________

Signature (s) _____________________________  ____________________________

Address _________________________________

cell phone no  _____________________________

Car make, model, color & license No./State:   -  OK to skip this

Home Phone no _____________________________        

e-mail _______________________

Visa or Master Card # _______  _______  _______  _______       Expires   _____ / _____  Credit Card to be imprinted

Contact us by calling 835-5333  or  message  831-1000   valdez@alaska.com  Lodging options  www.valdezlink.com/lodging.htm

If the check doesn't come from the office before you leave,

Do you authorize something that you would pay and be reimbursed by the Extension office?

If yes, How much?  _____________________________

Each mobile's rent for the week of Oct 26 thru Oct 31 was $500

with all dishes cleaned

& the unit picked up

& looking neat & orderly upon move out.