F O B FORM

FOX HILL FARM

CLUBHOUSE SECURITY SYSTEM

FOB (KEY) CONTROL FORM

DATE: __________/__________/__________

NAME(s): (Resident or Vendor: ______________________________________________

ADDRESS: ____________________________________________________________________

PHONE: (_____) _____-__________ (_____) ______-_________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Indicate number of “FOBS” required:

One _____ Two _____ Three _____ Four _____ Other (#) _____

Check appropriate box – List “FOB” numbers:

_____ Issue new FOB #: __________ __________ __________ __________ __________

_____ Returning FOB #: __________ __________ __________ __________ __________

_____ Loss of FOB #: __________ _________ __________ __________ ___________

Lost/Replacement FOB: $25 charge; payable to Fox Hill Farm

Paid: __________ Date: _____/_____/_____

_____ Defective FOB #: __________ __________ __________ __________ __________

Defective/Replacement #: __________ __________ __________ __________

_____ Transfer of FOB from above name to:

Name: ____________________________________________________________

Address: ____________________________________________________________

X ______________________________________ _____/_____/______

Authorized Signature/Manager Date

X_______________________________________ _____/_____/______

Resident/Vendor Date