Email
*
First Name
*
Last Name
*
Address
*
Phone
*
Event Date:
*
Accept Terms and Conditions
*
As a Member of Century Farm I have read the Rental and Use Agreement and fully accept all of its terms and conditions. I understand that I take full responsibility for all guests and other users of the facility and premises and will comply with the terms of this agreement. I understand that should I or a member of my event fail to abide by the above rules my privileges shall be revoked.
Note: This is a holding fee. You will only be charged upon approval.
Credit Card #:
*
Name as Shown on Credit Card:
*
Expiration Date:
*
CVC Code (3#s on Back of Card):
*
Billing Address if Different From Above
*
* required information
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