Xelevate Facility Visitor Access Form

Name*

First NameLast Name

Company

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Office Number

Please enter a valid phone number.

Cell Phone*

Please enter a valid phone number.

Name of Referring Party*

First NameLast Name

Xelevate Destination Visiting:*

DC/VA - 13870 Taylorstown Rd. Leesburg, VA 20176NC - 200 Airport Rd. Washington, NC 27889

Date of Expected Visit Start*

Date

Date of Expected Visit End*

Date

Reason for Visit:*

U.S. Citizen:*

YesNo

I acknowledge that Treetop Properties, LLC and Xelevate, LLC (collectively “Xelevate”) are permitting me to access and use the premises located at Taylorstown Road, Leesburg, Virginia 20176, on a non-exclusive basis, during the dates and times notified by Xelevate to me, for the purpose of visiting Xelevate’s facilities and engaging in any related activities expressly permitted by Xelevate. I further acknowledge that I have reviewed and agree to the Xelevate VISITOR ACCESS TO PREMISES AND FACILITIES TERMS AND CONDITIONS with respect to visiting, accessing, and using the premises and facility as a visitor, including but not limited to receiving a tour of the facility’s features. Such XELEVATE VISITOR ACCESS TO PREMISES AND FACILITIES TERMS AND CONDITIONS are hereby incorporated by reference into, and form an integral part of, this Xelevate Tour/Visitor Access Acknowledgement and Agreement. I HEREBY CONSENT TO ELECTRONIC TRANSACTIONS IN ACCORDANCE WITH SECTION 13 OF THE VISITOR ACCESS TO PREMISES AND FACILITIES TERMS AND CONDITIONS.

I acknowledge that the City of Washington, NC, the Washington-Warren Airport Authority, and Xelevate, LLC (collectively “Service Provider”) are permitting me to access and use the premises located at 200 Airport Rd. Washington, NC 27889 on a non-exclusive basis, during the dates and times notified by Service Provider to me, for the purpose of visiting Service Provider’s facilities and engaging in any related activities expressly permitted by Service Provider. I further acknowledge that I have reviewed and agree to the VISITOR ACCESS TO PREMISES AND FACILITIES TERMS AND CONDITIONS with respect to visiting, accessing, and using the premises and facility as a visitor, including but not limited to receiving a tour of the facility’s features. Such XELEVATE VISITOR ACCESS TO PREMISES AND FACILITIES TERMS AND CONDITIONS are hereby incorporated by reference into, and form an integral part of, this Xelevate Tour/Visitor Access Acknowledgement and Agreement. I HEREBY CONSENT TO ELECTRONIC TRANSACTIONS IN ACCORDANCE WITH SECTION 13 OF THE VISITOR ACCESS TO PREMISES AND FACILITIES TERMS AND CONDITIONS.

Signature*

XELEVATE TOUR/VISITOR ACCESS ACKNOWLEDGEMENT AND AGREEMENT