Coupon Request Form

2. 

6. Lake Ridge Property Address*

8. Mailing Address

   (If different from Property Address)

10. First Name*

11. Last Name*

13. Phone*

14. Email

    The Weekly News Flash keeps you in the loop of all that's happening in your community!

16. Reason for Request*
    -- Select One --Did not receive coupon book in mailLost/misplaced coupon book

    Upon submission of request, a new set of payment coupons will be mailed to you from LRPRA. We will contact you if further information is needed.

20. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
22. Electronic Signature*

23. Date*
    Date

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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field