Name: __________________________________________________________________

Ponderosa Address: _______________________________________________________
_______________________________________________________________________

Mailing Address: __________________________________________________________
_______________________________________________________________________

Phone Number: _______________________________________

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 : _______________________________________________________

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OFFICE USE ONLY:
Pool Card Number: ____________________________________

Issued by: _______________________________________________________________

Date: _______________________________________________