eliseo Early Reservation Payment Step 1 of 3 33% OriginatorName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Date of Birth* MM slash DD slash YYYY PhoneSecond Person* Yes No Is there a co-applicant?Co-Applicant Name* First Last Co-Applicant Email Co-Applicant Date Of Birth* MM slash DD slash YYYY Co-Applicant Phone Tacoma Lutheran Retirement Community Priority Club Agreement This Priority Club Agreement (this “Agreement”) is made this _______ day of ___________________, 20______ (the “Effective Date”) between Tacoma Lutheran Retirement Community not-for-profit corporation (the “Community”) and ______________________________ and _______________________ (“the Applicant(s)”). The Applicant(s) have made a non-interest bearing, non-binding deposit in the amount of: One Thousand Dollars ($1,000.00) – the (“Expansion Priority Club Deposit”) THEREFORE, in consideration of the foregoing, the Community and the Applicant(s) agree as follows: 1. Upon notification when floor plans and pricing become available, Applicant(s) is requested to provide additional information in accordance with the Community’s standard admission procedures. Applicant’(s) priority position for selecting among the available apartment homes will be based upon the Effective Date of this Agreement. 2. The Expansion Priority Club Deposit constitutes a non-binding Reservation Agreement in accordance with applicable Washington State statutes. 3. This Agreement may be terminated in writing at any time by either party and upon such termination the full Expansion Priority Club Deposit will be refunded to the Applicant(s) within thirty (30) days of receipt of written notice of termination. 4. Should the Applicant(s) enter into a binding Residence and Services Agreement with Tacoma Lutheran Retirement Community in the future, the Expansion Priority Club Deposit will be credited against the additional reservation deposit due at execution of such binding Residence and Services Reservation Agreement. 5. Any notice to Applicant(s) from Community shall be given in writing to address provided by Applicant(s) in this Agreement. Any notice to Community from Applicant(s) shall be sufficiently given if mailed or emailed to: Tacoma Lutheran Retirement Community | Attn: Director of Marketing tstewart@TacomaLutheran.org 1305 N Highlands Parkway Suite A-5, Tacoma, WA 98406 Or to such other address as the Community may later advise Applicant(s) in writing. By checking this box you are agreeing to the terms of the above Priority Club Agreement.* I Agree Deposit Amount Price: Total $0.00 Credit Card*Card Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.
