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BROOKWOOD
Access
Card Acceptance Form I, ___________________________, hereby accept full responsibility for the
use of access card number ____________________, which enables 24-hour access
to building __________ at I accept use of the card for myself only and will not let anyone else use
my card for access to I understand that there is a $25 charge for either a new or a replacement card. If the card is lost or stolen, I will report it immediately to The
Frederick Ross Company at If I misuse the system and it malfunctions, I agree to pay The Frederick
Ross Company at AGREED AND ACCEPTED this __________ day of _______________________, 200__. SIGNATURE (key card
user)_________________________________ I approve of this employee’s access to
building(s) ___________ at SIGNATURE (supervisor)_______________________TITLE____________________ Level of access:
______ Health
Club FOR OFFICE USE
ONLY: Key entered:______ ______ |