Name: _______________________________________________________________________________________________________________________
E-mail: _______________________________________________________________________________________________________________________
Street Address: __________________________________________________________________________________________________________
City: _______________________________________________________ State:_______________________________________________________
Zip/Postcode:__________________________________________________Country:________________________________________________
Phone Number Day:__________________________________________Evening:_________________________________________________
ArrivalDate ___________________________________________________DepartureDate________________________________________
Total number of Guests: _________________________
Names of all Guests and age if under 18:
1.___________________________________________________2.______________________________________________________
3.___________________________________________________4.______________________________________________________
5.___________________________________________________6.______________________________________________________
7.___________________________________________________8.______________________________________________________
9.___________________________________________________10._____________________________________________________
Pool Heating ( $150 per week): YES / NO
Other Requirements:
I have read and agree to abide by the rental terms and conditions, and enclose in either cashier's check, money order or personal check (US based bank only) for my deposit $200 or full rental costs _______________.
Please make check payable to: Ming Yuan.
Name:_____________________________Signature:_______________________________Date:______________________________
Mail to : Ming Theresa Yuan, 506 Vestry Drive, Ambler, PA 19002, U.S.A.
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