Report Damage

Five Star Lodging Reservation Number*

Unit Name*

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Check-Out Date*

Name of Registered Guest*

First Name

Last Name

Are you the Registered Guest?*

Yes No

Your Name*

First Name

Last Name

Email Address*

Phone Number*

Please describe the extent of damage:*

Please upload photo(s) of the damage below:*

No File Chosen

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Additional Photo 1:

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Additional Photo 2:

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List any additional witnesses and their contact information below:

Token

Please provide payment for any costs in excess of $250.*

Payment Authorization: You hereby authorize MFSL to charge the card entered above (or as backup, your credit card on file with MFSL) for the cost of repair or replacement (1) for any Unintentional Damage exceeding the Waiver Cap (including any parts costs or third party vendor expenses); and (2) for all Intentional Damage.**