Point Reyes Vacation Home
                                                    Rental Reservation Form

Name(s)______________________________________________________________________
          
           ______________________________________________________________________

Email: ___________________________     Fax: (____) __________________
                                                                                                       C: (____) ________________
Number in party: ______   Phones:   W: (_____) ______________ H: (____) ________________

Address:  _______________________________________________________________________
           (street)                                          (city)                                                               (state/zip)

Employer: ______________________________________________________________________
             (name)                                     (supervisor)                                           (phone)

Address:  _______________________________________________________________________
              (street)                                          (city)                                                              (state/zip)

Driver’s License Number: _________________________________________   State: __________

Emergency Contact:  
_______________________________________________________________________________
                    (name)                                                                                               (phone)
       
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Calculation of Rental Fees *except holidays                    Dates requested
                                                                               (Call (415)740-7405 to confirm dates)
____________  x  $235*              =             $  _______________         _____________________
(# days)               ($ per night)

____________  x  $1410*            =             $  _______________         _____________________
(# weeks)             ($ per week)                                                                         

         Total Rental Fees                          $ ________________   

          Rent Deposit Due                          $ ________________    (See rent deposit below)   

         Cleaning                                        $ ________100.00  
        
         Security Deposit (Refundable)      $ ________250.00          (See policy below)   

          Occupancy Tax (10%)                   $________________

         Amount Enclosed           =             $  _______________     (Payable at time of reservation)

Rental Policy: No Pets. No Smoking. Maximum Occupancy: 6
Security Deposit: $250 is deposited as security. Landlord may use said deposit as necessary to
remedy any Tenant defaults in payment of long distance telephone bills or to repair damages caused
by Tenant. Tenant agrees to comply with all reasonable rules or regulations. Tenant shall keep the
premises, furniture, furnishings, appliances, and fixtures in good order and condition and pay for any
repairs to the property caused by Tenant's or Tenant's invitee’s negligence or misuse. Tenant further
agrees to vacate the premises on the above indicated end date and time.  A $50 fee will be
charged for not cleaning the barbeque grill.  Occupancy shall be terminated and a $500 fee
will be charged for pets, smoking in the house, unauthorized guest or exceeding
occupancy.

Rent Deposit: In full if less than 90 days before arrival; 50% if more than 90 days before arrival.

I HAVE READ, UNDERSTAND & AGREE TO THE FOREGOING RENTAL POLICY

______________________________________________________________
                 (please sign here)                                       (date)

Please Print form and fill out.  Then mail, fax or email form to:  
Steve Rosenberg ~775 E. Blithedale Avenue, # 363 ~ Mill Valley, CA 94941
Fax:   (415)380-9300 ~ steve@PointReyesVacationHome.com