Lock Box Code - Authorization To Store Digitally

Lock Box Code - Authorization to Store Digitally

Filling out and submitting this form authorizes Roadhaven to keep your lock box information on file digitally in the Front Office. Lock box information will be available to Roadhaven Security and/or Superstition Fire and Medical District and/or Apache Junction Police Department in case of emergency. You can revoke your authorization at any time without reason by submitting a written request to the Roadhaven Front Office.
Resident Name*

First NameLast Name
Roadhaven Address*
Phone Number*
Please enter a valid phone number.
Location of Lock Box*
Example - Next to front door
Lock Box Code*
Email
example@example.com
Additional Comments
Signature*

Clear
Date

MonthDayYear
Date
You consent and agree that your use of a keypad, mouse, or other device to select an item, button, icon, or similar act/action while using any electronic service we offer; constitutes your signature, acceptance, and agreement as if signed by you in writing. Further, you agree that no certification authority or other third-party verification is necessary to validate your electronic signature; and that the lack of such certification or third-party verification will not in any way affect the enforceability of your signature or resulting contract between you and Roadhaven. You understand and agree that your eSignature executed in conjunction with the electronic submission of this form will be legally binding and such transaction will be considered authorized by you and constitutes your agreement to be bound by the terms and conditions of the electronic service as they exist on the date of your eSignature on this form.
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Lock Box Code - Authorization to Store Digitally