Use Application

Today’s date: _______________________________________

Rental date(s) requested: ___________________________

Facility space requested: ___________________________

Move in day/time: _______________Event time(s): ___________________Move out day/time: _______________

Nature of the event: ________________________________________________________________________________

Check if applicable: _____Live Music _____Admission/Donation Charged _____Alcohol service required

How did you hear about Manatee Convention Center:

_____________________________________________________________________________________________________

(Contract issued as follows)

Applicant’s full name

_____________________________________________________________________________________________________

Doing business as d/b/a

_____________________________________________________________________________________________________

Person (print) with capacity to sign contract _______________________________________________________

Title ______________________________________________________________________________________________

Mailing address

_____________________________________________________________________________________________________

Business address

_____________________________________________________________________________________________________

Day phone (____)_______________ Other phone (____) __________________ Fax (____) ___________________

Email address: ______________________________________________________________________________________

Circle One: (Legal Identity)

Sole Proprietorship / Partnership / Association / Corporation in the State of_________

Natural person lawfully residing in ___________________(County), _________(State)

Non-Profit Agency in Manatee County, FL / Sales Tax Exempt (Attach certificate)
(If you are sales tax exempt - please attach a copy of your exemption certificate)

Person to be contacted for event set up if other than Applicant (This person may incur charges on Licensee’s behalf)Contact person’ full name:

_____________________________________________________________________________________________________

Address

_____________________________________________________________________________________________________

Day (______)________________ Ext. ___ Other (______)___________________ Fax (______)________________

Email address________________________________________________________________________________________

PREVIOUS FACILITIES USED (complete only if checked) _______

Name _________________________________________________________________

Address ______________________________________________________________

Telephone ____________________________________________________________

Date and Event _______________________________________________________

BANK REFERENCES (complete only if checked) ________

Bank Name ____________________________________________________________

Address ______________________________________________________________

Telephone ____________________________________________________________

Account No.___________________________________________________________

Authorization for verification of Space Utilization History, Bank Account Records, Credit Report and Public Records.

I hereby authorize the release of Convention/Conference/Meeting Space Utilization History, Bank Account Records, Credit Report and Public Records whether by telephone, fax, photo copy or original to Manatee Convention and Civic Center. I agree to hold harmless Manatee Convention and Civic Center and all providers of information on the prospective licensee described above. I hereby covenant and warrant that the information provided on this Application is true and accurate. Any resulting contract shall be voidable by the Center if this information is shown to be false or inaccurate. The Manatee Convention and Civic Center reserves the right to review and approve applicants and events to determine their acceptability for the facility. Completion of a written contract is required to secure your rights.

Signature _______________________________________________________________________ Date _____________

All dates are tentative until a signed License Agreement is received.