PORTUGUESE AMERICAN CLUB

130 East Prospect Avenue

Mount Vernon, New York, 10550

914-664-8346

RENTAL AGREEMENT

I hereby pay_________________deposit as partial payment, towards the rental of the

following facilities of the Portuguese American Club.

Ballroom......$______________

Kitchen........$______________

Cleaning.......$______________

TOTAL.......$______________

This deposit is not refundable if renter cancels this contract within two weeks of

scheduled date of the event. The facilities are rented for the date of ________________

for a period no more than four hours, starting at _________for the purpose of:

Dance..............Wedding..........Meeting............Other...............___________________

By city ordinance, the facilities may not be used after 1:00 a.m. The balance due

is payable before the scheduled event begins. No personal checks will be accepted.

Name of Renter: _______________________________________________________

Address and Phone: _____________________________________________________________

The renter agrees to pay for all property damages caused during this event. The Club assumes no

responsibility whatsoever for any misconduct, and/or injuries sustained by anyone, during this

scheduled event. The renter assumes all these responsibilities.

Signature of Renter: _____________________________________________________

Portuguese American Club: ________________________________________________

President

Date: __________________________________________________________________