CAPTAIN’S KEY DEPENDENT DISTRICT GATE ACCESS REGISTRATION
*No refunds or returns on working, broken, or damaged security devices after 72 hours of purchase
PROPERTY OWNER INFORMATION: (All Property Owners’ Signatures Required)

Name: 	

Address: 	City: 	

State: 	Zip Code:  	

Phone: Home: 	Work 	Cell 	

Signature: 	Date: 	

Signature: 	Date: 	

VENDOR OR GUEST INFORMATION:

Name: 	

Company Name: 	

Industry: 	

Address: 	City: 	

State: 	Zip Code:  	

Phone: Home: 	Work: 	Cell: 	

Signature: 	Date: 	

*The signed property owners on file, according to the Palm Beach County Property Appraisal website, will be held liable for any and all damages to Captain’s Key gate system that is caused by them or any person to whom security devices were issued as seen in the Captain’s Key Records.
For Office Use Only

Product	Price	Device IDNumber	Qnty	Total	Payment Type	
						
Transponder	$35.00					
Swipe Card	$10.00					
Gate Key	$15.00