Fill and Sign the Application to Join Security Association Form

Application to Join Security AssociationPage 1 of 3 Application to Join Security Association REGRISTRATION AND MEMBER PROFILE FORM (Keep a copy for your records) Security Association (Name) (Names of Neighborhoods Covered) Membership (Complete Fields Below) Registration Form Name Neighborhood Billing Address City, State, Zip Code Property Address City, State, Zip Code Home Phone: Work Phone: Email Address: Billing Information: Dues are prepaid so that the number of patrol hours can be determined each month. There are two options to pay your dues. Please check one of the boxes below. Check or Money Order (a one time annual fee payable to HNSA for the amount Application to Join Security AssociationPage 2 of 3 of $480.00) Monthly EFT (a monthly electronic fund transfer of $ from a checking or savings account). If you are choosing to pay monthly by electronic banking draft, please complete the EFT form and attach a canceled check . Remit: Neighborhood Services Corporation (City, State, Zip Code) (Phone Number) (E-Mail Address) Member Profile (Complete Fields Below – Write Clearly using Dark Ink) Information Emergency Phone Contact Number (fastest contact): Name Phone No. Description of Cars at Home Regularly (Model/Color/tag #) Car 1: Car 2: Car 3: Car 4: Names of Other Individuals Living at Residence or Person 1: Regular and Authorized Visitors Person 2: Person 3: Person 4: Person 5: Pets In House In Yard No Pets Alarm Company Name Phone No. Application to Join Security AssociationPage 3 of 3 Handling Instructions for Mail: Pickup Leave in mailbox House Checks Newspapers Pickup Leave on/in (location) Miscellaneous Fence Gates Locked: Yes No Lights left on: Porch Upstairs Downstairs Other ( )