Extended Stay Request Form

Please answer all fields before submitting the form.

Primary Adult Guest First, Middle & Last Name:(Required)

Home Address (Physical address only. No P.O. Boxes.):(Required)

City:(Required)

State:(Required)

Zip Code:(Required)

Primary Phone:(Required)

Secondary Phone:(Required)

Emergency Contact (If different from secondary.)

Email Address:(Required)

Driver’s License Number and Issuing State:(Required)

Vehicle Tag:(Required)

Vehicle Make(Required)

Vehicle Model(Required)

Purpose of Your Visit:(Required)

Work

Vacation

If work, what type of work?(Required)

Secondary Adult Guest First, Middle & Last Name:(Required)

Home Address:(Required)

City:(Required)

State:(Required)

Zip Code:(Required)

Primary Phone:(Required)

Secondary Phone:(Required)

Email Address:(Required)

Vehicle Tag:(Required)

Vehicle Make:(Required)

Vehicle Model:(Required)

Driver’s License Number and Issuing State:(Required)

Length of Stay:(Required)

Check–in Date:(Required)

Check–out Date:(Required)

Type of RV:(Required)

Travel Trailer

5th Wheel

Motorhome

RV Model Year(Required)

RV Registration(Required)

Length of RV:(Required)

Number of Slides:(Required)

30 or 50 Amps(Required)

Number of Children (Over 16 is considered an adult.):(Required)

First Child's Name / Age:(Required)

Second Child's Name / Age:(Required)

Third Child's Name / Age:(Required)

Number of Pets:(Required)

Pet's Name / Breed:(Required)

Payment Preference:

Cash

Check

Credit – 3% Convenience Fee with Credit or Debit Card Payments

Please check each box indicating that you have read the terms and conditions, and will abide them. Note: Read each carefully as part of your agreement to these terms and conditions. Violating these terms and conditions will results in fines and or termination of your stay.(Required)

Electronic Signature and Acceptance(Required)

By checking this box, I acknowledge and agree the information in this form is correct and I agree to abide by the terms and conditions set forth. Checking this box is considered an electronic signature and shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.