Community Room Request Form

Name of Organization*

Brief Description of Event*

Number of Attendees Expected (Max Capacity is 50)*

Contact Person*

Contact Phone Number*

Contact Email Address*

Contact or Organization Address*

Please re-enter the main phone number if it is the same as your cell phone number.

Requested Date*

Second Choice Date*

Requested Event Start Time*

:

Notes: Our team will set-up chairs and tables in advance of your arrival. Please include any additional set-up time you require when choosing your start time. Events that start or end outside Keller Market business hours will incur a $20/hour additional charge.

Requested Event End Time*

:

Please include any clean-up time you may require. Our team will take down chairs and tables after your departure.

Total Event Hours*

Based on the number of hours for your event, check the applicable charges below:*

Up to 2 hours total - $50
Up to 4 hours total - $75
Up to 6 hours total - $125
Up to and beyond 8 hours - $150
We will have additional hours outside Keller Market business hours - $20/hour

How many round tables requested? Each table seats 7 guests:

How many chairs requested?

Will food and beverage be served?*

Yes
No

If applicable, name of caterer:

If applicable, please upload proof of food license or permit:

Each file can be no larger than 8 MB. The type of files you can upload are: PDF, .jpg or .jpeg

Drop files here or

Accepted file types: jpg, jpeg, pdf, Max. file size: 20 MB.

Acknowledgment*

By my submission of this online request form I understand that:

My requested date and time are not reserved until this application is reviewed and approved by Keller Market House.
I will be presented with a rental agreement that conveys terms and rules for use of the Keller Market House Community Room and Kitchen space.
The final amount due will be noted in the rental agreement and a deposit may be required.

Typed Signature of Person Completing this Form:*

Date of Submission

Keller Market Community Room Rental Application