Host Damage Protection Payment Request Form
Company Name
HostCare Solutions
Form Reference Number
HDPF-2024-003
Date of Request
December 20, 2024
Host Information
Name of Host: Emma Johnson
Property Address: 123 Main Street, Springfield, IL, 62704
Contact Details:
- Phone: +1-234-567-8901
- Email: emma.johnson@hostcare.com
Guest Information
Name of Guest: David Parker
Booking Reference Number: BK-2024-9876
Stay Period: December 1, 2024 – December 10, 2024
Damage Details
Date of Incident: December 9, 2024
Description of Damage: Broken window and stained carpet in the living room caused during the guest’s stay.
Estimated Repair/Replacement Cost: $800
Supporting Information
Attached Documents:
- Photos of damage (attached as evidence)
- Repair estimates from vendor
- Incident report
Payment Request Details
Amount Requested: $800
Currency: USD
Purpose of Payment: Reimbursement for damages caused by the guest during their stay.
Payment Due Date: December 30, 2024
Authorization Section
Requested By:
- Name: Emma Johnson
- Signature: _______________________
- Date: December 20, 2024
Approved By:
- Name: Sarah Williams
- Signature: _______________________
- Date: December 21, 2024
Remarks/Comments
Reimbursement requested promptly to cover repair expenses and ensure property readiness for the next booking.
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