Passholder Termination Request Acknowledgement


Date of Request:

Accommodation Number:

Club Account Number:

Name of Passholder:

By signing this termination request, I respectfully request that my deposit be returned to me and I relinquish my Passholder rights for Summer 2020. I also acknowledge that all deposits will be mailed to me within 6-8 weeks of the inspection (club employee and Passholder in attendance for inspection) pursuant to a satisfactory and cleaned out accommodation.

Passholder signature:

Fax to: Silver Gull 718.634.6300 Surf Club 718.634.6700
E-mail to:

Last updated: May 28, 2020

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Mailing Address:

210 New York Avenue
Staten Island, NY 10305


(718) 354-4606

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