2. 
6. Disclosure Packet Agreement*

   As required by the Virginia Property Owners' Association Act, I hereby request that LRPRA furnish the Association Disclosure Packet for the property indicated above. I understand fees will be collected at settlement. If settlement does not occur within 60 days of delivery of the disclosure packet, the fees become the personal obligation of the property owner and are due immediately. I acknowledge that an inspection of the exterior of the property (except for Condos or East Lake Ridge properties) will be performed and photos of the property will be taken in the preparation of the packet.

   1. I agree.
8. Persons on Deed
10. First Name*
11. Last Name*
12. Phone*
13. Email*
15. First Name
16. Last Name
17. Phone
18. Email
20. Lake Ridge Property Address*
21. City*
22. State*
23. Zip Code*
25. Format & Delivery
27. Format*
    -- Select One --Electronic (PDF): 5 Copies for $176.64 + Inspection Fee of $141.31 = $317.95Paper (Mailed via USPS): 2 Copies for $211.96 + Inspection Fee of $141.31 + Additional Cost for PostagePaper (In-Person Pick-Up at LRPRA Office): 2 Copies for $211.96 + Inspection Fee of $141.31 = $353.27
28. Optional Additional Services

    1. Expedited Service (provided within 5 business days): $70.66
    2. More than 5 Electronic Copies: $35.33 each
30. Mailing Address*
32. Pick Up Recipient Name*
34. Pick Up Recipient Email*
35. Pick Up Recipient Phone*
37. Mail Recipient Name*
38. Mail Recipient Phone*
40. Address*
41. City*
42. State*
43. Zip Code*
45. Email Recipient #1*
46. Email Recipient #2
47. Email Recipient #3
49. Email Recipient #4
50. Email Recipient #5
54. Fee Collection
    Fees will be collected at settlement. If settlement does not occur within 60 days of delivery of the disclosure packet, the fees become the personal obligation of the property owner and are due immediately.
56. Duplicate / Replacement Packets
    Once the disclosure packet is sent out, duplicate or replacement copies will not be provided. If a duplicate or replacement packet is needed, another POA Disclosure Packet or Update will need to be requested.
58. Exterior Inspection Agreement*

    I acknowledge that an inspection of the exterior of the property (except for Condos or East Lake Ridge properties) will be performed and photos of the property will be taken in the preparation of the packet.

    1. I agree.
62. 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.
64. Electronic Signature*
    Signature of Seller or Seller's Authorized Agent
65. Date Submitted*
    Date Submitted
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field