Refund Request Form If you would like to request a refund for a credit on your account, please fill out this form. Association Name*Lot #Owner Name* First Last Property Address* Street Address City State / Province / Region ZIP / Postal Code PhoneEmail* Description*Type the payment information aboveAttach proof of payment/copy of cleared checks by clicking on the “Browse” button to locate your attachment. If payment is from your online bill pay, please contact your bank for a copy of the cleared check and then submit for a refund. A request is not a guarantee of a refund. **All requests will be reviewed and further documentation may be requested if needed**Attachment #1Attachment #2Attachment #3Attachment #4I, the homeowner, declare under penalty of perjury that the above facts are true and correct. This document is an official request for a refund of the listed payments. I hereby agree to not dispute the payments listed for refund with my bank. The Homeowners Association and Planned Development Services will not be responsible for any mistakes, errors, or additional requests made by the above listed owner/entity.* I, the homeowner, hereby agree to the above statements Δ
