HILLS PINEY CREEK HOA POOL PASS FORM AND DIRECTORY

HILLS AT PINEY CREEK HOA POOL PASS FORM

Dear Homeonwer/s! Please fill out the form below so the HOA can set up the new pool entry/security system and update our records and homeowner directory.

HOMEOWNER CONTACT INFORMATION

OWNER 1

First Name

Last Name

Phone 1

(###)

###

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Email 1

OWNER 2

First Name

Last Name

Phone 2

(###)

###

####

Email 2

Resident/Child over the age of 16

First Name

Last Name

Phone 3

(###)

###

####

Resident/Child over the age of 16

First Name

Last Name

Phone 4

(###)

###

####

UNIT ADDRESS

Off Site Mailing Address

IN CASE OF EMERGENCY CONTACT

CONTACT 1

First Name

Last Name

Phone 1

(###)

###

####

CONTACT 2

First Name

Last Name

Phone 2

(###)

###

####

Please check a box below if you approve/not approve for your contact information to be published in the HPC directory.

I/We APPROVE of my/our information to be published in the HPC directory

I/We DO NOT approve of my/our information to be published in the HPC directory

Signature - By typing in your name below you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this form and you have provided accurate and legal information.

First Name

Last Name