Rentee

Address

City		State		Zip

Telephone (day)   (night)
Date Requested		Day of Week

Type of Event

Check One:   Seated Dinner _____ Stand Up Reception  _____ Starting Time of Event: __________________ am/p.m. Ending Time of Event __________________ am/p.m. (Not to exceed 1:00 a.m.) Rehearsal Time (if desired): Date/Day __________________ Time: __________________ Approximate number of guests:__________________

Caterer		Phone
Florist		Phone
Band		Phone
Security		Phone
Will Alcohol be Sold		Admission charged

Comments

Rental Agreement:
I understand I am applying for a date to rent The Lowe Gallery. Submitting the application and deposit does not imply confirmation of my requested date. Confirmation will be in written form. I also understand once the rental application is approved, the rental deposit is non-refundable. I understand and have received a copy of The Lowe Gallery policies and procedures and agree to the terms there of.

Waiver and Release:
The undersigned hereby understands, acknowledges and agrees that The Lowe Galleries, Inc. d/b/a/ The Lowe Gallery (the Gallery) is a retail establishment whose sole business purpose is the sale of fine art. By renting the Gallery facilities, the undersigned hereby agrees to waive, release, discharge and forever hold harmless the Gallery, it's employees, directors and shareholders from and against any and all claims, demands and liabilities to third parties including, but not limited to, liability arising from any losses, liabilities, claims, demands, damages, suits or expenses incurred or which may be incurred as a result of the undersigned's rental of the Galleries facilities.

In Witness whereof, the undersigned has executed and delivered this Release this ___ day of _______, 20___ .

By:

Name of Individual or Corporate Authorized Signatory.

Witness

Office Use Only

Date received		Confirmation Lt. Sent
Deposit received		Balance due
Date Approved		Damage deposit amt.