Priority Wait List Agreement


The undersigned (“Applicant”) and Suffield by the River (“SBTR”), agree as follows:

  1. SBTR acknowledges receipt from the Applicant of a Five Hundred Dollar ($500.00) deposit, made on this date, to secure a position on the Priority Wait List for occupancy at SBTR. If an apartment is immediately available, then this Agreement shall serve as a Reservation Agreement. The Applicant understands that the types of apartments available are studio alcove, one (1) bedroom, one (1) bedroom deluxe, two (2) bedroom and two (2) bedroom deluxe. The Applicant has specified below the type(s) of apartment(s) for consideration. As specified in this agreement, the Applicant will be notified, in the order in which the Applicant’s name appears on the Priority Wait List, of the availability of the type(s) of apartment(s) specified below. No notice will be given with regard to type(s) not specified.
  2. The Applicant is specifically interested in the following type(s) of apartment(s): (Please check all that apply)


  3. When the Applicant is notified of the availability of an apartment specified above, the Applicant may:
    1. Accept the apartment within three (3) days by agreeing that he/she will take occupancy (or begin paying rent) within thirty (30) days of being notified of such availability. Upon acceptance the Supervisor of Assisted Living Services (the “SALSA”) will schedule an assessment of the Applicant. If the SALSA determines that the Applicant is not appropriate to reside at SBTR then the deposit will be refunded; or
    2. Decline the apartment, and cancel this Priority Wait List Agreement; or
    3. Decline the apartment, and keep this Priority Wait List Agreement in effect.
  4. If the Applicant cancels this Priority Wait List Agreement, the deposit will not be returned. If the Applicant elects to keep this Priority Wait List Agreement in effect, Applicant’s position on the Priority Wait List will remain at the top. If Applicant declines an apartment three (3) times, Applicant’s position on the Priority Wait List will go to the bottom.
  5. The Applicant may request an update of his/her Priority Wait List position at any time.
  6. At the time of occupancy, the $500.00 wait list deposit will be applied to the first month’s rent.
  7. The Applicant’s position on the Priority Wait List is subject to SBTR’s obligation to give first choice to those current Residents of SBTR who have requested notification about other available apartments.
  8. The monthly rent for the apartment, which Applicant selects, shall be at the then prevailing rate at the time of Applicant’s acceptance of the apartment.
Name
Birthdate of Main Occupant
Second Occupant (if any)
Birthdate of Second Occupant
Phone
Address
City
State
Zip
Email Address (Applicant's or Responsible Party)
Do you want to receive the monthly invoice at this email address?  Yes No
Name as you would like it to appear on a brass name plate outside your apartment:
Dated this day of
Signature of Applicant or Responsible Party:
Present Street Address:
(if different from above)
Telephone Number:
(if different from above)
Contact Person for Notification of Apartment Availability:
Telephone Number:
Accepted:
By: Authorized Agent
Date:

After submitting this form online, you will receive a completed copy in your email, please print and mail a signed copy along with your deposit check.

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