COMPANY / CORPORATION DESIGNATING FORM

DATE: ______________

SUB: _______________  BLOCK _______________  LOT: _______________

Company Name: _______________________________________________________

Address:______________________________________________________________

City: _____________________________  State: _______  Zip: __________________

 

Is herby designating:  Employee: ___________________________________________

                                Employee/Spouse: ____________________________________

Signature of Authorized Person: ____________________________________________

Accepted by POA Employee: ______________________________________________

Requests should be dropped off at the POA General Office at Town Center or mailed to:

Bella Vista Property Owners Association
Attn: Membership Services
101 Town Center
Bella Vista, AR. 72714

Phone: (479) 855-8000
Fax: (479) 855-8006

01/20/2005