insert building address here BUILDING ACCESS CARD REQUEST FORM

1)Only tenants and their employees are eligible. By signing this form, you acknowledge that the people listed are eligible.

2)Picture I.D. (copy) must be provided for each person receiving a building access card.

3)Please indicate after-hours access schedule requested for each person. For example, John Smith M-F 7am – 8pm.

4)A $10 deposit per access card will be billed on your rent statement. When the access card is returned to the Office of the Building in good usable condition, the deposit will be credited on the next rent statement.

5)Tenant is responsible for proper administration of cards. Please collect cards from terminated employees or request, in writing, for the Management Office to invalidate an access card. If cards are not returned, your deposit will be forfeited.

6)Any lost or stolen cards must be reported to the Management Office immediately. There is a replacement fee of $10.

7)Access cards are not transferable. Any card being found to be used in an unauthorized manner or by someone other than to whom it is registered may be immediately revoked without reinstatement.

8)The premises may, at any time, be subject to access control and/or video surveillance. This is for Landlord’s convenience only and is in no manner security.

9)Tenant is responsible for making its card holders aware of these guidelines.

ACCESS CARD INFORMATION (Check all applicable items)

Card(s) for New Hire

Replacement for defective card(s) # ______

Name Change

Replacement for lost card(s) # ______

Delete card(s) #______

Company Name:______Date: ______Suite # ______

1) Name:Mobile #:

Email: Driver’s License #:

Requested Hours: Building Holidays?:

Card# (to be assigned by Mgt. Office):______

2) Name:Mobile #:

Email: Driver’s License #:

Requested Hours:Building Holidays?:

Card# (to be assigned by Mgt. Office):______

3) Name:Mobile #:

Email: Driver’s License #:

Requested Hours:Building Holidays?:

Card# (to be assigned by Mgt. Office):______

4) Name:Mobile #:

Email: Driver’s License #:

Requested Hours:Building Holidays?:

Card# (to be assigned by Mgt. Office):______

I, hereby, authorize the Management Office to issue access cards, as described herein, to the employees(s) designated by me, above, to facilitate after-hours building access for my employees. Furthermore, I understand that my company shall not rely on the access card(s) to provide any additional security or surveillance to my suite.

AUTHORIZED BY: Name: Title:

Signature:Date:

Please return to the Management Office or via fax. (copy this form for additional cards)

TO BE COMPLETED BY MANAGEMENT OFFICE
Amount to be charged or deposit posted (if applicable):
Approved by:Signature:Date:

(note: this form is for tenant’s internal record keeping and does not have to be returned to landlord)

Insert company name or letterhead here

EMPLOYEEBUILDING ACCESS CARD REQUEST FORM

insert building address here

PRINT NAME: ______

DEPARTMENT: ______

Please Circle One:

New Card Replacement Card

I, the undersigned, hereby acknowledge receipt of the building access card described below andpromise to return the building access card to ______(insert person or department) upon request from ______or termination of my employment.

I agree to reimburse for replacement cost of $15.00 if my building access card is lost, damaged, or otherwise unavailable for return upon request from building management or .

I understand that my building access card is issued to me personally and cannot be shared with someone else for temporary use, or passed on to a new employee upon my departure from insert company name and/or insert building address here Any lost cards must be reported immediately. I agree to abide by the access control policy of the building and violation of these rules could result in permanent revocation of my access privileges.

A copy of the building’s access control policy is on file with insert person or departmentand available for review upon request.

SIGNATURE: ______DATE:______

FOR AFTER-HOURS BUILDING ACCESS

AUTHORIZATION BY _____ (insert title) ONLY

Authorized Name:______

Authorized Signature:______Date:______