Application for Use of Town Facility
Town of Exeter, 10 Front Street, Exeter, NH 03833
Fax #: 603-777-1514 or email:
Facility Requested: Wheelwright Room Nowak Room
Representative Information:
Name: Address:
Town/State/Zip: Phone:
Email: Date of Application:
Organization Information:
Name: Address:
Town/State/Zip: Phone:
Reservation Information:
Type of Event/Meeting: Date:
Start Time:
# of tables: # of chairs:
List materials being used for this event:
Will food/beverages be served? Description:
Cleaning Deposit: A cleaning deposit of $100 is required of any user serving food or beverages (small room on the right
permitted only). If the town determines after use
that the building acceptably cleaned, the deposit fee will be returned to user.
Liability Insurance Required: Certificate of Insurance and endorsement/provisions to be submitted with completed application.
Required Amount: General Liability/Bodily Injury/Property Damage: $1,000,000 per occurance, $2,000,000 aggregate; the
Town of Exeter must be listed as an additional insured.
Keys: Access to a town building after normal business hours requires a key sign out. Forms and keys can be obtained from
the Town Manager’s office at the Town Office during normal business hours (there is no other option for obtaining a key).
A key can be collected up to 24 hours before your event (with the exception of Sunday events).
Signing below acknowledges receipt of and agreement to all rules, regulations and requirements pertaining to the use of a
town facility. Permit approvals are contingent upon proper insurance and fees paid to the Town of Exeter.
Applicant signature: Date:
Authorized by the Select Board /Designee: Date:
Office Use Only:
Liability Insurance: On file In-process Will receive by
Fee: Paid Amount:
End Time:
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