Name of Company:

Mailing Address:

City, State and Zip Code:

Telephone Number(s):

Fax:

E-mail:

Contact Name:

List reservation locations if more than the one noted above:

Percentage of stays at which location: (i.e. 40% beach/ 60% mountain):

Demographics of guests:

Avg age of guests:

% of singles:

% Couples::

% Families:

Avg income level:

Avg # of guests per reservation:

Avg # of units/houses available for rent per year:

Avg cost per rental property per week:

Loss history - experience with security deposit, breakage, how much refunded:

Include brochures, catalog, flyers........ of properties, procedures......

Program to be sold as per following:

Voluntary in lieu of security deposit - Reservation/group/person has the option to choose the non-refundable peace of mind coverage fee rather than put up a refundable security deposit.

Accept    Decline