APPLICATION TO RENT
OUR THEATRE TO OTHERS

   2.    Location address of the theatre____________________________________
          _______________________________________________________________

   3.    Name & telephone number of contact person_________________________

   4.    Name of the lessee [renter]________________________________________

   5.    Address of lessee [renter]_________________________________________
          _______________________________________________________________

   6.    Briefly describe nature of event for which the lessee intends to rent your facility
          ____________________________________________________________________

   7.    Rental date[s] _________   8.  Estimated number who will attend ____

   9.    Does the lessee have any valid / collectible insurance?   YES        NO
          [Provide written confirmation, signed and dated by a legal representative of the
          lessee, that the lessee does not have any valid / collectible insurance]

   10.  Does lessee intend to provide, serve, distribute, sell alcoholic beverages at this
          event?    YES   NO   If yes, they must provide their own liquor liability insurance
          because our insurance will provide no liquor liability coverage.

     Mail to:  Ponta, Castle & Ingram Agency         Fax to:  248-258-1964
                    700 East Maple Road
                    Birmingham, MI  48009