Resident Access Pass Request Form

Resident Access Pass Request Form
To enjoy all access-controlled amenities at Mosaic, each qualifying household member must complete the Access Pass Form and Facilities Use Agreement.

Residents can enter amenities using either:
- A mobile pass on their smartphone
- An access card printed with their name and photo for identification.
Who Qualifies?

Permanent residents (living in the home year-round) aged 14 or older, as well as buyers of homes under construction, are eligible for access.

Important Details:
- Age and residency verification are required before issuing an access card
- Each household receives two (2) complimentary passes; additional passes are $25 each.
- A separate application must be submitted for each pass requested.
Thank you for helping us keep Mosaic amenities secure and enjoyable for all!
Who Is Applying for This Access Pass*

First NameLast Name
Mosaic Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How many people reside at this address?

Adults (over 18):   Number*
Youths (14-17):   Number
Under 14:   Number
Check the box for either a Mobile Access Pass or an Access Card (Please check only one box)*

Mobile Access PassAccess Card
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date

Who is this access card for?*

Homeowner (Name is on title)Adult Occupant (18+ years of age, not on the title)Youth Occupant (14-17 years of age)Tenant (Name is on 12+ month lease)

Homeowner (Name is listed on Title)

In order to issue an access pass, we need to see proof of residency in the form of the first page of your home sales contract.
Upload Proof of Residency*

*Image or scan of first page of contract
Cancelof

Adult Occupant (18+ years of age, not on title)
In order to issue your access pass, we need proof of residency in the form of a government-issued ID (with Mosaic address). Please upload an image or scan of your ID which shows your Mosaic address below.

*IF YOUR HOUSE IS STILL BEING BUILT, we can print you an access card that will expire once the homeowners have closed on your home. Once this card expires, you MUST show proof of residency in the form of a government-issued ID with your Mosaic address printed on it to have your card reactivated.

*IF YOUR HOUSE HAS FINISHED BEING BUILT, you MUST show proof of residency in the form of the Mosaic address being printed on your government-issued ID before you can request an access card.
Upload Proof of Residency

*DOES NOT QUALIFY: Bills, car insurance, and other types of mail.
Cancelof
**If your house is still being built, check the box to let us know you will need an access card with an expiration date. If you uploaded your proof of residency above, select "I uploaded my proof of residency above"*

I understand that I will be receiving an access card which will expire once we have closed on our home.I uploaded my proof of residency above
Estimated Closing Date
Please type the estimate date of closing for your home. This will be the date your temporary address card expires.

Youth Occupant (14-17 years of age)

In order to issue a Youth access pass, we need to verify that the occupant is at least 14 years old. Please check the box below to let us know that you understand you MUST BRING WITH YOU either a copy of the child's birth certificate, passport, or government-issued ID when you pick up the access card. We cannot issue the access pass until we see this proof of age.
I understand that I must bring either the child's birth certificate, passport, or government-issued ID with me in order to pick up the access card.

Tenant (Name on 12+ month lease)

In order to print your access card, we need to see proof of residency in the form of your 12+ month lease with your name on it.
Upload Proof of Residency

Cancelof

Access Pass Photo

In order to issue your access pass, your photo must meet the following criteria: Your head must face the camera directly with full face in view. You must not be wearing any hats or sunglasses or any items that cover your face. The photo must have been taken in the last 6 months.
Upload photo*

Cancelof

Access Pass Payment / Replacement Policy

Every household will receive (2) access passes complimentary of the association, any additional passes will be $25 each. If I misplace my access pass, I will have to pay the $25 replacement fee.
I have read and understand the statement above.

Facilities Use Agreement

The Facilities Use Agreement must be completed on behalf of myself and/or my entire household before I can pick up my access cards or be issued mobile passes. After you click submit below, you will automatically be redirected to another page to fill out your waiver.
I have read and understand the statement above.
Should be Empty:

Homeowner (Name is listed on Title)