CLIA Lake Harvesting Services Form

Cossayuna Lake Improvement Association

CLIA Lake Harvesting Services Form
You must be an Association member in order to sign up for lake weed harvesting. If you are not a member, please sign-up via the Online Sign-Up page on the Association website (www.cossayunalake.com), or complete and mail in the All-In-One form on the Forms & Applications page of the Association website. Our goal is to perform multiple harvesting passes during the season, dependent upon weather and equipment conditions.

* Required fields
Harvesting Costs
- $125 per lot
- $75 per hour for additional harvesting
Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number*

Area CodePhone Number
I would like to have my lot(s) harvested each time the crew tours the lake:*

YesNo
Email Address*
example@example.com
List the property address(es) of the lot(s) to be harvested:*
Harvesting Number(s) if known:
How many lots would you like to be harvested? ($125 per lot)*

123456
OPTIONAL: How many additional hours of harvesting would you like? ($75 per hour)

0123456
Harvesting Calculation
Click on your preferred method of payment below (PayPal Checkout, PayPal Credit, or Credit or Debit Card payment). After you complete your payment information, click on the submit button to complete the transaction. Your account or card will not be charged until you complete the submit process.

If you are paying by Credit or Debit card, do NOT click on the option to save your card information - selecting that option will take you to the PayPal login screen.
Amount Due:

prevnext( X )
USDLAKE HARVESTING SERVICES

loading smart payment buttons...

The payment is ready! It will be completed once you submit the form.
Questions can be directed to the following individuals:

Membership: Bob Reilly 631.897.4811 or dakotabr@optonline.net

Harvesting: Tim Hopkins 518.466.8653 or thop920@gmail.com

Lake Management: Sheila Rappazzo 518.429.8312 or sarappazzo@yahoo.com
CLIA is a 501(c)3 nonprofit organization. Donations are tax exempt to the extent of the law. A copy of our most recently filed financial report is available from the Charities Registry on the New York State Attorney General's website (www.charitiesnyc.com) or, upon request, by contacting the New York State Attorney General, Charities Bureau, 28 Liberty Street, New York, NY 10005 or us at POB 81, Cossayuna, NY 12823-0081. You may also contact the New York State Office of the Attorney General at 212.416.8401.
Should be Empty:

Cossayuna Lake Improvement Association