HOUSECHECK SERVICES APPLICATION

APPLICATION TO SUBSCRIBE TO THE LAKE NAOMI - TIMBER TRAILS

2024/2025 HOUSECHECK PROGRAM
HOMEOWNER NAME *

First NameLast Name
MEMBER NUMBER (if applicable)
MAILING ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CELL PHONE NUMBER *
Please enter a valid phone number.
EMAIL ADDRESS*
example@example.com
LOCATION OF LAKE NAOMI / TIMBER TRAILS HOUSE*
NAME OF SNOWPLOWING CONTRACTOR (This portion must be completed)*
CONTACT NUMBER FOR ALARM (Plan D Subscribers only)
Please enter a valid phone number.
EMERGENCY CONTACT NUMBER
Please enter a valid phone number.
RELATIONSHIP
FOR PLAN G OR PLAN H ONLY:
WEEK #1 FROM

MonthDayYear
Date
TO

MonthDayYear
Date
WEEK #2 FROM

MonthDayYear
Date
TO

MonthDayYear
Date
WEEK #3 FROM

MonthDayYear
Date
TO

MonthDayYear
Date
WEEK #4 FROM

MonthDayYear
Date
TO

MonthDayYear
Date
WEEK #5 FROM

MonthDayYear
Date
TO

MonthDayYear
Date
WEEK #6 FROM

MonthDayYear
Date
TO

MonthDayYear
Date
WEEK #7 FROM

MonthDayYear
Date
TO

MonthDayYear
Date
WEEK #8 FROM

MonthDayYear
Date
TO

MonthDayYear
Date

Please Choose Plan(s) desired:

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

I/we enter into this agreement with the understanding that the Lake Naomi Club will use its best efforts to check my/our house for obvious signs of harm or damage and to inform the homeowner (or designated agent of the homeowner) of any problems revealed by this check. I/we understand that the Lake Naomi Club is not an insurer against loss nor does the Club guarantee in any way the condition of my/our residence. I/we agree that I/we will continue all homeowners insurance in full force during the term of this agreement. Furthermore, I/we agree to hold the Lake Naomi Club harmless against any and all loss or liability resulting from any claim asserted against the Club by reason of its rights and obligations under this service agreement.
SIGNATURE OF HOMEOWNER

Clear
Should be Empty: