2025 Monthly Payment Agreement

This form is designed for our LMOA Members who wish to utilize our convenient payment plan, allowing you to pay your annual dues on a monthly basis.

Please note the following:

We require all payments to be submitted on or before the last business day of each month.
If your statement shows a balance forward, you must include this amount in your first payment to qualify for this agreement.
Only Members in Good Standing can participate in the 2025 monthly payment plan.
A monthly installment fee of $5.00 per lot will be applied to your account each month, which will be included in your total payment below.

If you agree to these stipulations, please continue to fill out and submit this form. Thank you!

Name (as it appears on your photo ID)*

First NameLast Name

Email*

example@example.com

Phone Number:*

Please enter a daytime phone number

Billing address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please enter your LMOA property street address(es). Be sure to Click 'Save To Form' after entering each address:*

By signing below, I confirm my choice to pay the LMOA 2025 Annual Dues on a monthly basis, as specified in my option above. This agreement will remain effective until one or more owners provide written notice to the Lake Monticello Owners’ Association (LMOA) of its termination, allowing reasonable time for LMOA to process the change, or until December 31, 2025, whichever comes first. I acknowledge that a $35 fee will apply to my account if a check is returned due to insufficient funds. Personal checks should be made payable to the Lake Monticello Owners’ Association and sent to 41 Ashlawn Boulevard, Palmyra, VA 22963. For inquiries about your account, please reach out to 434-589-8263.

Signature*