POOL CARD APPLICATION
The Ponderosa Community Club Office
21100 Cayuse Street
Leavenworth, WA 98826
Name: __________________________________________________________________
Ponderosa Address: _______________________________________________________
_______________________________________________________________________
Owner(s) home/billing address: _______________________________________________
City: _________________________________ State: __________ Zip: _________
Home Phone Number: _______________________________________
Alternate phone number: ____________________________ (in case of emergency)
Email Address: ___________________________________________________________
Are you a new owner? _____Yes _____No
If yes, purchased from: _____________________________________________________
Approximate closing date: ___________________________________________________
Have you had a Ponderosa Pool Card before? _____Yes _____No
(Note: If you have had a card previously, there is a $25.00 replacement feel. Checks payable
to Ponderosa Community Club.)
Signature of Owner : _______________________________________________________
------------------------------------------------------------------------------------------------------------
POOL CARD #: _______
Issued by: ______________________
Date: __________________________