PROPERTY OWNER: ___________________________________________

STREET ADDRESS: ___________________________________________

CITY: _________________________________________ STATE: __________ ZIP: ___________

CLUSTER _________________ LOT _______________

I, ____________________________________________________________________OWNER/AGENT request disclosure information about The Four Winds Club, Inc. according to the terms of the Virginia Property Owners' Association Act (POAA). If you have the owner's letter of authorization or Power of Attorney, please attach it to this request form. The POA Act requires The Four Winds Club, Inc. to release the documents ONLY to the owner or his/her authorized agent.

Agent's Name, Company, Address and Telephone Number:

AGENT NAME ___________________________________________________________

STREET ADDRESS ____________________________________________________________

CITY: _________________________________________ STATE: __________ ZIP: ___________

TELEPHONE NUMBER: _______________________________________

Disclosure packet will be picked up by: Owner _______ Agent ______

Daytime Phone: _______________________________

Email Address: ___________________________________________

The packet will be available for pick-up fourteen (14) days after we receive your request. If the "ready date" falls on a Saturday, the packet will be available the preceding Friday. To prepare the packet, The Four Winds Club, Inc. will inspect your property and MAY need to go on your property to do so.

Signature of Requester: ____________________________________________

Daytime Phone: _______________________________________-

Check should be made payable to "The Four Winds Club, Inc."

(Information below to be completed by The Four Winds Club, Inc.) DISCLOSURE DOCUMENTS FEE: $50.00

PAID BY: Personal Check ___ Certified Check ___ Money Order ___

DATE RECEIVED: _________________________