This Is Your Walden Woods Community Service Monthly Assessment Coupon Register

THIS IS YOUR WALDEN WOODS COMMUNITY SERVICE MONTHLY ASSESSMENT COUPON REGISTER.

PAYMENT REGISTER

YOUR ACCOUNT NUMBER IS:

PAYMENT FOR THE YEAR DUE BY THE 14TH OF EACH MONTH

$2.00 Late fee for payments made after the 14th

MONTH CHECK NUMBER DATED AMOUNT

JAN

FEB

MAR

APR

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

CHECK NO. ______ACCT. NO. JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______

CHECK NO. ______ACCT. NO. ______JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______

CHECK NO. ______ACCT. NO. ______JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______

CHECK NO. ______ACCT. NO. ______JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______

CHECK NO. ______ACCT. NO.______JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______

CHECK NO. ______ACCT. NO. ______JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______

CHECK NO. ______ACCT. NO. ______JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______

CHECK NO. ______ACCT. NO. ______JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______

CHECK NO. ______ACCT. NO. ______JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______

CHECK NO. ______ACCT. NO. ______JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______

CHECK NO. ______ACCT. NO. ______JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______

CHECK NO. ______ACCT. NO.WW00201 JAN FEB MAR APR MAY JUN

NAME ______JULY AUG SEP OCT NOV DEC

ADDRESS ______Late fee due after the 14th of the month.

______Please circle the month this payment is

for and send a coupon for each month

REMIT TO: WALDEN WOODS CSA paid.

7900 STEUBENVILLE PIKE

SUITE 20 AMOUNT DUE: 41.00

IMPERIAL, PA. 15126 LATE FEE: 2.00

AMOUNT PAID: ______

Email address: ______