B and K's Lincoln City Condo

(Please copy & past page into email: or download MSWord doc and attach to email or fax to 503-371-6321 or mail to Bruce Ahrendt, 1722 Marquette Lane S. Salem, Or. 97306)

First Name

Last Name

Mailing Address Line 1:

Mailing Address Line 2:

City

State

Zip Code:

Home Telephone:

Cell Phone:

Email:

A Paypal payment request will be sent to your email address for payment of deposit or rental.

Date of Arrival:

Date Leaving:

Names of People staying:

1.	Under 18
2.
3.
4
5.
Over 5 requires Owner approval. 6.
7.

Vehicle License Numbers

# State

#  State