ARDOIN CLIMATE CONTROLLED STORAGE
 RENTAL AGREEMENT 
Customer Name : ______________________________________________________________   PLEASE  M AKE  CHECKS  PAYABLE  TO:

Customer Driver's License # : ___________________________________________________       DEVIN K. ARDOIN

Customer Home Phone : ________________________________________________________         5412 CROOKED CREEK PKWY.

Customer Work Phone: _________________________________________________________         VILLE PLATTE, LA 70586

Customer Address : ____________________________________________________________
Cell: ________________________________________________

E-mail: ______________________________________________

By electing to provide its e-mail address, Occupant agrees that notice by Owner may be given to Occupant via e-mail. 
Are you, your spouse or any of your dependents in the Military/Reserves? 
	Yes: __ No:_lf Yes, Contact information: 	_ 
EMERGENCY CONTACT: 
	
Name: 		_ 
	
Address: 		_ 
	
City/State/Zip: 		_ 
	
Phone: 	_ 
	
Email 		_ 
DESCRIPTION OF CONTENTS:(circle all that apply) Household Goods, Furniture, Boxes, Trunks, Suitcases, Toys, Sporting Goods, 
Tools. NO PERISHIBLE GOODS, NO HAZARDOUS NOR COMBUSTABLE MATERIALS SHALL BE STORED IN THIS FACILITY.  
LIENHOLDERS: Occupant represents that he/she owns or has legal possession of the personal property in his/her space(s). Occupant 
attests that all the personal property in his/her space is free and clear of all liens and secured interests EXCEPT for the items listed 
below: 
	Property Description  : _________________________________________________________________________________________ 
	CONTRACT DETAIL: 

First Late Fee: $20
Second Late Fee: $20 
Third Late Fee:$20
NSF Fee: $25
                    Clean-Up Fee:$100 

Transaction Date: 
Unit Number: 
Unit Description: 
Monthly Due Day: 
Monthly Rental: 
Door Access Code: 
Move In Date: 

ALL PROPERTY STORED UNDER A RENTAL AGREEMENT MAY BE SOLD OR OTHERWISE DISPOSED OF IF NO PAYMENT 
HAS BEEN RECEIVED FOR A CONTINUOUS SIXTY-DAY PERIOD WHEN DUE. 
This Rental Agreement, (hereinafter called "Agreement"), made and entered into this date as set forth above, by and between the self-service storage facility identified above as agent for Owner, (hereinafter called "Owner") and Occupant identified above, (hereinafter 
called "Occupant"), whose last known address is set forth above. For the consideration hereinafter stated, the Owner agrees to let 
Occupant use and occupy a space as listed above in the self-service storage facility, situated in the city and county listed above in the 
state of Louisiana, hereinafter referred to as "Space". Said space is to be occupied and used for the purposes specified herein and 
subject to the conditions set forth, beginning on the Rental Agreement date listed above and continuing month to month until 
terminated. 
1. RENT: "Space", as used in this agreement, will be that part of the self-service storage facility described above. The Occupant agrees 
to pay the Owner for the use of the space and improvement thereon, the monthly sum listed above as the Monthly Rate. Monthly 
installments are payable in advance at the office of the self-storage facility on or before the rental due date and a like amount for each 
month thereafter, until the termination of this agreement. Owner acknowledges receipt of the sum set out above showing payment 
through the date shown above. If any monthly installment is not paid by ten (10) days from the due date, or if any check in payment is 

dishonored, Occupant shall be deemed to be in default. Default can also be the Occupant's failure to perform any terms or conditions of 
this Rental Agreement or Occupant's breach of the peace. In the event of Occupant's default, Owner may, without notice, deny the 
Occupant access to the property located in the self-storage facility. Owner may place a different padlock on the rented premises over 
which only the Owner and his agents have control. Occupant agrees and understands that partial payments made to cure a default for 
non-payment of rent will not delay or stop the foreclosure and sale of Occupant's property. Partial payments do not waive or avoid the 
legal effect of prior notices given to Occupant. Only full payment on Occupant's account prior to the published auction date will stop the 
scheduled sale of the property. Customers account must be in good standing to receive any promotions or discounts. Cash can only be 
accepted during office hours. Do not deposit cash in the afterhours drop boX/slot. Owner is not liable for any cash placed in the drop 
boX/slot. Occupant is encouraged to obtain a rent receipt for cash payments. 
	2. DENIAL OF ACCESS: If rent is not paid within ten (10) days of the monthly due date, Owner may without notice deny the Occupant 
access to the property located in the self-storage facility. Access will be denied to any party other than the tenant unless said party 
retains door code and key to lock on Space or has supplied Owner with written authorization from the tenant to enter the Space. 
Occupant's access to the facility may also be conditioned in any manner deemed reasonably necessary by Owner to maintain order on 
the premises. Such measures may include, but are not limited to, restricting hours of operation, requiring verification of occupant's 
identity and inspecting vehicles that enter the premises. Additionally, if Occupant is renting more than one Space at any given time, 
default on one rented Space shall constitute default on all rented Spaces, entitling Owner to deny access to Occupant to all rented 
Spaces. 
3. FEES: Concurrently with the execution of this Rental Agreement, Occupant shall pay to Owner a nonrefundable NEW ACCOUNT 
ADMINISTRATION FEE in the amount as set forth above. A bill for the monthly rent will not be sent unless requested. However, 
Occupant may elect to pay an additional fee as an INVOICE FEE, set forth by Owner. Occupant acknowledges that late payment of 
monthly rent will cause Owner to incur costs not contemplated by this lease, the exact amount of such costs being extremely difficult to 
fix. Therefore, if any monthly rent is received after DAYS from the rental due date, Occupant shall pay to Owner a FIRST LATE 
	FEE for each month rent is past due. Furthermore, if any monthly rent payment is received after 30 DAYS from the rental due 
date, a SECOND LATE FEE will be assessed for each month rent is past due. Late fees are assessed at the full and sole discretion of 
the Owner. Said late charges are due and payable without demand from Owner. The parties agree that these late charges represent a 
fair and reasonable estimate of the costs the Owner will incur by reason of late payment by Occupant. If any check is dishonored for 
any reason, said late charges shall be due and payable in addition to a return check charge identified above as an NSF FEE. If 
Occupant's property is processed for sale at public auction, Occupant shall be responsible for a minimum public auction processing fee 
shown above as AUCTION FEE. If Occupant's lock must be cut, Occupant shall be responsible for LOCK CUT FEE identified above. 
4. USE AND COMPLIANCE WITH LAW: (a) The space nanied herein is to be used by the Occupant solely for the purpose of storing 
any personal property belonging to the Occupant. The Occupant agrees not to store any explosives, or any flammable, odorous, 
noxious, corrosive, hazardous or pollutant materials or any other goods in the space that would cause danger or nuisance to the space 
or facility. Occupant shall not store any improperly packaged food or perishable goods, or other items that may attract rodents, vermin, 
or other infestation in the Space. The Occupant agrees that the property will not be used for any purposes unlawful or contrary to any 
ordinance, regulation, fire code or health code and the Occupant agrees not to commit waste, nor to create a nuisance, nor alter, nor 
affix signs on the space, and will keep the space in good condition during the term of the Agreement. The occupant agrees not to store 
jewels, furs, heirlooms, art works, collectibles or other irreplaceable items having special or emotional value to the occupant. Occupant 
waives any claim for emotional or sentimental attachment to Occupant's property. There shall be NO HABITABLE OCCUPANCY of the 
space by humans or pets of any kind for any period whatsoever and violation of these prohibitions shall be grounds for immediate 
TERMINATION of the Agreement. If hazardous substances are stored, used, generated or disposed of on or in the premises or if the 
premises become contaminated in any manner for which the Occupant is legally liable, Occupant shall indemnify and hold harmless the 
Owner from any and all claims, damages, fees, judgments, penalties, costs, liabilities or losses, and any and all sums paid for 
settlement of claims, attorneys' fees, consultant and expert fees, arising during or after the lease term and arising as a result of that 
contamination by Occupant. (b) Occupant agrees not to conduct any business out of space, and further agrees that the space is not to 
be used for any type of work shop, for any type of repairs or for any sales, renovations, decoration, painting, or other contracting in the 
space. Use of any utilities on premises is strictly prohibited except by express written agreement and arrangement with Owner and for 
an additional Utility charge set forth by Owner. Unless given written permission by owner, violation of these prohibitions shall be 
deemed a default and shall be grounds for immediate Termination of this agreement and shall cancel Occupant's right of Occupancy. 
Occupant agrees to hold Owner, other Occupants and third parties harmless and indemnify, safe and defend such persons from any 
loss resulting from the violation of this provision. 
5. CONDITION AND ALTERATION OF PREMISES: Occupant assumes responsibility for having examined the premises and hereby 
accepts it AS IS, being in good order and condition and agrees to pay Owner promptly for any repairs to the space resulting from 
negligence or misuse by the Occupant, Occupant's invitees, licensees and guests. Occupant understands that all unit sizes are 
approximate and enters into this Rental Agreement without reliance on the estimated size of the Space. Occupant shall make no 
alterations or improvements to the space without prior written consent of Owner. Should Occupant damage or depreciate the Space, or 
make alterations or improvements without the prior consent of the Owner, or require the Owner to incur costs to clean the Space upon 
termination, then all costs necessary to restore the Space to its prior condition shall be borne by Occupant. Owner has the right to 
declare any such costs to repair as "rent" and non-payment of said costs entitles Owner to deny Occupant access to the Space. 
6. LIMITATION OF VALUE: Occupant agrees that in no event shall the total value of all property stored be deemed to exceed 
$5000.00 unless Owner has given permission in writing for Occupant to store property exceeding that value. Occupant agrees that the 
maximum value for any claim or suit by Occupant, including but not limited to any suit which alleges wrongful or improper foreclosure or 
sale of the contents of a storage unit is the total value referenced above. Nothing in this section shall be deemed to create any liability 
on the part of Owner to Occupant for any lost or damage to Occupant's property, regardless of cause. 

7. ABANDONMENT: This Agreement shall automatically terminate if Occupant abandons the Space. Occupant shall have abandoned 
the Space if Occupant has removed the locking device from the Space and IS NOT current in all obligations hereunder or lock is cut 
after default and it is determined, in the Owner's discretion, that the items in the unit have little or no value. Any property left in the 
Space may be disposed of by the Owner. Rent paid for month in which Occupant moves out early shall not be refunded. THERE ARE 
NO RENT REFUNDS. 
8. TERMINATION: This agreement shall continue from month to month unless Occupant or Owner delivers to the other party a five-day 
advanced written notice of its intentions to terminate the Agreement. Upon termination of this Agreement, Occupant shall remove all 
personal property from the space and shall deliver possession of the space to Owner unless such property is subject to Owner's lien 
rights as referenced in this Rental Agreement. If Occupant fails to fully remove its property from the space within the time required, 
Occupant shall be an Occupant at sufferance and Owner, at its option, may, without further notice or demand, either directly or through 
legal process, reenter the Occupant's unit and remove all property therefrom without being deemed guilty in any manner of trespassing 
or conversion. No refunds are allowed for partial- month occupancies. Occupant shall be charged a CLEAN UP FEE, identified above, if 
Owner is required to remove any debris from either inside or outside the rented Space after Occupant vacates the Space. 
9. OCCUPANT'S RISK OF LOSS: THE OWNER IS NOT A WAREHOUSEMAN ENGAGED IN THE BUSINESS OF STORING 
GOODS FOR HIRE, AND NO BAILMENT IS CREATED BY THIS AGREEMENT. THE OWNER EXERCISES NEITHER CARE, 
CUSTODY, NOR CONTROL OVER THE TENANT'S STORED PROPERTY. All property stored within or on the space by Occupant or 
located at the facility by anyone shall be stored at Occupant's sole risk. Occupant must take whatever steps he deems necessary to 
safeguard what is at the facility or in or on the space. Occupant shall assume full responsibility for who has the keys and access to the 
space. Owner and Owner's employees and agents shall not be liable for any loss of or damage to any personal property while at the 
rented premises arising from any cause whatsoever, including, but not limited to, theft, mysterious disappearance, vandalism, fire, 
smoke, water, mold, mildew, hurricanes, rain, tornados, explosions, terrorist acts, rodents, insects, Acts of God, the active or passive 
acts or omissions or negligence of the Owner, Owner's agents or employees. IT IS AGREED BY OCCUPANT THAT THIS RELEASE 
OF OWNER'S LIABILITY IS A BARGAINED FOR CONDITION OF THE RENT SET FORTH HERE AND THAT WERE OWNER NOT 
RELEASED FROM LIABILITY, A MUCH HIGHER RENT WOULD HAVE TO BE AGREED UPON. Owner does not promise safety or 
security of persons or property on the premises, and Owner had no duty of safety or security of same under any circumstances. Video 
cameras may be non-operational or unmonitored. Access control devices may be unmonitored and may occasionally malfunction. 
10. PERSONAL INJURY:Owner and Owner's agents and employees shall not be liable whatsoever to any extent to Occupant or 
Occupant's invitees, family, employees, agents or servants for any personal injury or death arising from Occupant's use of the storage 
space or premises from any cause whatsoever including, but not limited to, the active or passive acts or omissions or negligence of the 
Owner, Owner's agents or employees. 
11. INDEMNIFICATION OF OWNER: Occupant will indemnify and hold the Owner harmless from and against any and all manner of 
claims for damages or lost property or personal injury and costs including attorney's fees arising from Occupant's lease of the space on 
the facility or from any activity, work or thing done, permitted or suffered by Occupant in or on the space or about the facility. In the 
event that the space is damaged or destroyed by fire or other casualty, Owner shall have the right to remove the contents of the space 
and store it at the Occupant's sole cost and expense without liability for any loss or damage whatsoever, and Occupant shall indemnify 
and hold Owner harmless from and against any loss, cost, or expense of Owner in connection with such removal and storage. Should 
any of Owner's employees perform any services for Occupant at Occupant's request, such employee shall be deemed to be the agent 
of the Occupant regardless of whether payment for such services is made or not, and Occupant agrees to indemnify and hold Owner 
harmless from any liability in connection with or arising from directly or indirectly such services performed by employees of Owner. 
Notwithstanding that Owner shall not be liable for such occurrences, Occupant agrees to notify Owner immediately upon the 
occurrence of any injury, damage, or loss suffered by Occupant or other person in any of such circumstances. 

12. OWNER'S RIGHT TO ENTER: In cases where Owner considers it necessary to enter the space for purposes of examining the space for violation of this agreement or condition in the space or making repairs or alterations thereto, or to comply with this agreement, 
Occupant agrees that Owner, or Owner's representative, shall have the right without notice to enter into and upon the space and Owner reserves the right to remove contents to another space. 	
13. OWNER'S LIEN RIGHTS1. PURSUANT TO THE "SELF SERVICE STORAGE FACILITY ACT", TITLE 9, SECTIONS 4756-4760, 
AS AMENDED, LOUISIANA REVISED STATUTES, THE OWNER, HIS HEIRS, EXECUTORS, ADMINISTRATORS, SUCCESSORS, 
AND ASSIGNS HAVE A LIEN OR PRIVILEGE UPON ALL PERSONAL PROPERTY LOCATED AT THE FACILITY FOR RENT, 
LABOR, OR OTHER CHARGES, PRESENT OR FUTURE, IN RELATION TO THE PERSONAL PROPERTY AND FOR EXPENSES 
NECESSARY FOR ITS PRESERVATION OR EXPENSES REASONABLY INCURRED IN ITS SALE OR OTHER DISPOSITION 
PURSUANT TO LAW. THE LIEN ATTACHES AS OF THE DATE THE PERSONAL PROPERTY IS BROUGHT TO THE FACILITY 
AND CONTINUES SO LONG AS THE OWNER RETAINS POSSESSION AND UNTIL THE DEFAULT IS CORRECTED, OR A SALE 
IS CONDUCTED, OR THE PROPERTY IS OTHERWISE DISPOSED OF TO SATISFY THE LIEN PURSUANT TO LAW. IN NO 
EVENT SHALL THE LESSOR'S LIABILITY EXCEED THE PROCEEDS OF THE SALE. THIS LIEN COVERS ANY PERSONAL 
PROPERTY WHICH THE LESSEE STORES IN THE SPACE, EVEN IF IT IS OWNED BY SOMEONE ELSE. 

	. 
14. SECURITY AGREEMENT: This Agreement shall constitute a security agreement covering the contents (hereinafter referred to as 
"collateral") of the Space, and a security interest shall attach thereto for the benefit of, and is hereby granted to Owner by Occupant to 
secure the payment and performance of Occupant's default hereunder. Owner, in addition to all other rights and remedies it may have 
in such event, may exercise any right or remedy wish respect so the Collateral which it may have under the Uniform Commercial Code 
or otherwise. It is expressly understood that Owner retains its Owner's statutory lien. All rights of Owner hereunder or in law or in equity 
are cumulative, and an exercise of one or more of such rights shall not constitute a waiver of any other rights. Occupant hereby waives 
and renounces its right to the benefit of the exemptions provided under state law and as it may be amended. 
15. OCCUPANT'S LIABILITY: In the event of a foreclosure, it is understood and agreed that the liability of Occupant for the rents, 
charges, costs, and expenses provided for in this rental agreement shall not be relinquished, diminished or extinguished prior to 
payment in full. It is further agreed that Occupant shall be personally liable for all rents, charges, costs and expenses, including those 
incurred in the sale and/or disposition of the Occupant's property as provided for above. Owner may use a collection agency thereafter 
to secure any remaining balance owed by Occupant after the application of sale proceeds if any and Occupant shall be liable for all 
fees and costs for said collection. If any property remains unsold after foreclosure and sale, owner may dispose of said properly in any 
manner considered appropriate by Owner. 
16. ASSIGNMENT AND SUBLETTING: Occupant shall not assign this Agreement or sublet the whole or any portion of the space 
rented hereunder. 
17. WAIVER/ENFORCEABILITY:In the event any part of this Agreement shall be held invalid or unenforceable the remaining part of 
this Rental Agreement shall be in full force and effect as though any invalid or unenforceable part or parts were not written into this 
Agreement. No waiver by Owner of any provisions hereof shall be deemed a waiver of any other provision hereof or of any subsequent 
detaultor breach by Occupant of the same or any other provision. 
18. ATTORNEY'S FEES: In the event Owner obtains services of an attorney to recover any sums due under this agreement, for an 
unlawful detainer, for the breach of any Covenant or conditions of this Agreement, or in defense of any demand, claim, or action 
brought by Occupant, Occupant agrees to pay to Owner the reasonable costs, expenses, and attorney's fees incurred in such actions. 
19. SUCCESSION: This Agreement is binding upon the parties, their heirs, successors, personal representatives and assigns. 
20. GOVERNING LAW: This Agreement and any actions between the parties shall be interpreted by and governed by the laws of the 
State of Louisiana. 
21. WAIVER OF JURY TRIAL: Owner and Occupant waive their respective rights to trial by jury of any cause of action, claim, 
counterclaim, or cross complaint brought by either Owner against Occupant, or Occupant against Owner on any matter arising out of or 
in any way connected with this Rental Agreement, Occupant's use or occupancy of the storage space, or any claim of bodily injury or 
property damage or the enforcement of any remedy under any law, statute, or regulation. 
22. LIMITED WARRANTY: This Agreement contains the entire Agreement of the parties and no representation or agreements, oral or 
otherwise, between the parties not embodied herein shall be of any force or effect. The agents and employees of Owner are not 
authorized to make warranties about the space, premises, and facility referred to in this Agreement. Owner's agents and employees' 
ORAL STATEMENTS DO NOT CONSTITUTE WARRANTIES, and shall not be relied upon by the Occupant nor shall any of said 
statements be considered a part of the Agreement. The entire Agreement and understanding of the parties hereto is to be considered a 
part of the Agreement. This entire Agreement and understanding of the parties hereto is embodied in this writing and NO OTHER 
WARRANTIES are given beyond those set forth in this Agreement. The parties hereto agree that the IMPLIED WARRANTIES OF 
MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE and all other warranties, express or implied, ARE EXCLUDED 
from this transaction and shall not apply to the leased space, premises, and facility referred to herein. It is further understood and 
agreed that Occupant has been given an opportunity to inspect, and has inspected this space, premises, and facility, and that Occupant 
accepts such leased space, premises, and facility AS IS and WITH ALL FAULTS.

23. RULES: Owner shall have the right to establish or change the hours of operation for the Facility and to promulgate Rules and 
Regulations for the safety, care and cleanliness of the Space or the preservation of good order in the Facility. Occupant agrees to follow 
all Rules and Regulations now in effect, or that may be put into effect from time to time. 
24. Notices from Owner: All notices from Owner shall be sent by first class mail postage prepaid to Occupant's last known address or 
to the electronic mail address provided by the Occupant in this Rental Agreement. Notices shall be deemed given when deposited with 
the U. S. Postal Service or when sent by electronic mail. All statutory notices shall be sent as required by law. 
25. Notices from Occupant: Occupant represents and warrants that the information Occupant has supplied in this Rental Agreement 
is true, accurate and correct and Occupant understands that Owner are relying on Occupant's representations. Occupant agrees to 
give prompt written notice to Owner of any change in Occupant's address, any change in the liens and secured interest on Occupant's 
property in the Space and any removal or addition of property to or out of the Space within ten (10) days of the change. Occupant 
understands he must personally deliver such notice to Owner or mail the notice by certified mail, return receipt requested, with postage 
prepaid to Owner at the Facility address set forth above or bye-mail only if e-mail is acknowledged by Owner

26. CHANGES: All terms of this Agreement, including but without limitation, monthly rental rate, conditions of occupancy and other 
charges, are subject to change upon thirty (30) days prior written notice to Occupant. If changed, the Occupant may terminate this 
Agreement on the effective date of the change by giving Owner ten (10) days prior written notice to terminate after receiving notice of 
the change, If the Occupant does not give such notice, the change shall become effective and apply to his occupancy. 
27. OCCUPANT'S LOCK: Occupant shall provide at Occupant's own expense a lock for the space which Occupant, in Occupant's sole 
discretion, deems sufficient to secure the space. Space shall be immediately locked upon execution of the agreement. Occupant shall 
not provide Owner or Owner's agents with a key and/or combination to Occupant's lock unless deliveries are to be accepted by Owner 
on Occupant's behalf. If lock is not placed on unit or Space is found without a lock, Owner has the right to place a new lock on the 
Space to secure the Unit without creating a bailment. 
28. MILITARY SERVICE: In order to comply with SERVICE MEMBERS CIVIL RELIEF ACT it is Occupant's obligation to notify the 
Owner in writing that Occupant and any Occupant family member storing goods at the Facility are in active military service, in order to 
determine Occupant's qualifications under this Act. If Occupant's military status or Occupant's family member's military status changes, 
Occupant is required to notify the Owner in writing of this change immediately. 
29. FINANCIAL INFORMATION: Owner does not warrant or guarantee that any of Occupant's financial information, including, without 
limitation, credit card and bank account information, will not be stolen or otherwise compromised. Occupant waives and releases any 
and all claims or actions against Owner and its respective agents, employees and affiliates for damages arising from the use of said 
information by others. 
30. CLIMATE CONTROL : The climate controlled spaces are heated or cooled depending on outside temperature. The 
climate controlled spaces do not provide constant internal temperature or humidity control and Owner does not guarantee that 
temperature and humidity will not fluctuate. Occupant releases Owner and its respective agents, employees and affiliates from all 
liability for damage to stored property from fluctuations in temperature or humidity from any cause including the negligence of Owner or 
its respective agents, employees or affiliates. Occupant understands that there is a risk of the growth of mold and/or mildew on 
Occupant's stored property, even in a climate controlled Space. Owner recommends that Occupant periodically inspect the Space and 
the property, taking any and all actions necessary to protect Occupant's property. 
31. PERMISSION TO CALL. FAX. E-MAIL OR TEXT: Occupant recognizes Owner and Occupant are entering to a business 
relationship as Owner and Occupant. As such, to the extent any Federal or State law prohibits Owner from contacting Occupant by 
phone, fax, e-mail or text, Occupant hereby consents to Owner phoning, faxing, e-mailing and texting Occupant with marketing and/or 
other business related communications. 

NOTICE TO OCCUPANT: DO NOT SIGN THIS AGREEMENT BEFORE YOU READ ALL PAGES (This is a multi-page document), 
AND FULLY UNDERSTAND THE CONTENTS CONTAINED HEREIN. KEEP A COPY OF THIS AGREEMENT TO PROTECT YOUR 
LEGAL RIGHTS. OCCUPANT HEREBY ACKNOWLEDGES BY SIGNING THIS AGREEMENT THAT HE HAS READ, UNDERSTOOD 
AND ACCEPTS ALL THE TERMS AND CONDITIONS EXPRESSED IN THIS MULTI-PAGE AGREEMENT.

Owner:    	_    DATE ____________________________
Facility Manager 
	Occupant: 	_ DATE ____________________________
(signature) 
(Print Name)