• Reservation Application

    Please fill information out completely.
  • Personal Information

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  • Hospitalization & Medical Insurance

  • Person(s) to be Notified in Case of Emergency

  • Power of Attorney

  • How Mail Should be Delivered

  • Applicant's Financial Assets and Income

  • Social Security

  • Pensions

    Must include type of pension and address
  • Veterans Administration

  • Company

  • Other Income

  • Rent From Real Property

  • Dividends from Securities

  • Interest from Bank Accounts

  • Income from Annuities

  • Other Income

  • Assets

    Make sure address and account numbers are filled in and accurate.
  • Bank Accounts

  • Safety Deposit Box

  • Stocks

  • Bonds

  • Real and Personal Property

    We will require proof of current market value, proof of loan balance, equity or title.
  • Life or Annuity Insurance

  • Plan of Payment for Cost of Care at The Argyle

  • The information given on this reservation application is correct. I hereby apply for admission to The Argyle and give permission to the following institutions to supply the Argyle with verification of financial information supplied on this application.

    Note: State and Federal Law prohibits discrimination based on race, creed, color, national origin, sex, handicap, or sponsor. A copy of Power of Attorney for health care and finances must accompany this application and must be completed with accompanying documentation PRIOR to an applicant receiving consideration for admission to The Argyle.
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  • Should be Empty: