The Lakes of Jacaranda Homeowners Association, Inc. – Pool Fob Release Form

Complete all Mandatory Fields that have a red star *

Your Address in The Lakes of Jacaranda: *

Primary Contact Name *

First

Last

Primary Phone Number *

Secondary Contact Information

Complete the secondary contact information below if you would like to add an additional name to the front gate access call box.

Secondary Contact Name

First

Last

Secondary Phone Number

What is your Email Address: *

This email address will be used to send you a receipt once you complete this form

Number of Pool Fobs would you want to purchase? *

Will this be a replacement? *

Payments

Pool Fobs are $25.00 each.

The cost will be added to your account.

You can pay online or by check. No cash payments.

When paying by check, make the check payable to Lakes of Jacaranda and include your account number or property address on the memo line.

Acknowledgements *

These devices should remain with the home when sold or rented

Acknowledgements #3 *

As the Owner of record, I understand that I am responsible for the key fobs and their use by any Tenant and/or Guest.

Acknowledgements #2 *

I understand that all this information is factual and true to the best of your knowledge

Signature *

Clear Signature