Please Fill Out & Return Completed Form To

HBWPOA

PO BOX 1680

SHALLOTTE, NC 28459

or

hbwpoa@gmail.com

Owner Information:

Lot #:  _________         Name:  _________________________________________________

Holden Beach West Address:   _________________________________________________

Primary Email ______________________________________________________________

Secondary Email ____________________________________________________________ 

House Name:_______________________________________________________________

Home Phone: __________________             Beach Phone:  __________________________

Business Phone ________________              Mobile or Emergency Phone:  ______________

Permanent Address IF NOT a HB West resident:  __________________________________

City___________________   State __________________     Zip Code __________________

For Rental Properties:

Will you be renting your property?         _____Yes   ______No

Rental Agency:   _________________________________________________________

Rental Company Address:  __________________________       Phone _______________

Does your Rental Agreement prohibit large gatherings or parties?        Yes_______  No ______

Please Note: Article 47F of the North Carolina Condominium Act allows specific information to be public.  Should you not want any other details displayed in an owner only directory, please indicate here.

____________Yes, you may include                          ___________No, you may not include