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Facility or Group Site Application

SUN SOUNDS OF ARIZONA FACILITY APPLICATION (CONFIDENTIAL INFORMATION)
DATE _____________
FACILITY NAME _____________________________________________________________

CONTACT NAME/TITLE _______________________________________________________

ADDRESS _______________________________________________
CITY ______________________ZIP____________
PHONE ______-____________________

E-MAIL ____________________________________________

ADMINISTRATOR NAME/TITLE _______________________________________________________

MAXIMIUM NUMBER OF RESIDENTS ______________________________________

SELECT A DELIVERY METHOD: SCA RADIO FOR GROUP USE_______ TUNER________

Two copies of the Broadcast Schedule will be mailed to the contact at the facility each year. If you would like to receive the Program Guide in an alternate format please indicate the preferred format:
Braille_____Audio CD_____

AGREEMENT TERMS
Equipment loaned by Sun Sounds of Arizona or any of its volunteers or cooperating agencies remains the property of Sun Sounds.
Sun Sounds reserves the right to inventory the equipment at the facility with appropriate notice to the contact person listed or,
in their absence, the Administrator. The facility will pay current replacement value cost to Sun Sounds for any equipment that is lost, stolen, or otherwise unable to be produced for inventory within 30 days of the inventory request.
Signature _______________________________
Date _______________________________


FOR OFFICE USE ONLY
Delivered __________ Mailed __________ RECV”r# _____________ Freq_____________    DateRet'd____________
2ND#______________Freq_____________Rec'd_____________Ret'd_____________