CONCORDIA HOMEOWNERS ASSOCIATION

1 Clubhouse Road
Monroe Township, NJ 08831

RESIDENT EXTENDED VACATION INFORMATION FORM

NAME __________________________________________________________
ADDRESS ______________________________________________________
TELEPHONE NUMBER ____________________________________________
FULL VACATION ADDRESS _______________________________________
VACATION PHONE NUMBER _______________________________________
DATE LEAVING __________________________________________________
DATE RETURNING _______________________________________________
EMERGENCY CONTACT __________________________________________
THEIR PHONE NUMBER __________________________________________
DOES THIS PERSON HAVE A KEY?

YES

NO

DOES THIS PERSON HAVE YOUR ALARM CODE?

YES
NO
IF NO, NAME OF PERSON WHO HAS CODE________________________
WITH WHOM DO YOU HAVE A SERVICE CONTRACT? _________________
MY TELEPHONE WILL NOT BE TURNED OFF WHILE I AM AWAY IN ORDER
THAT MY ALARM WILL OPERATE.
SHOULD ANY PORTION OF MY ALARM SYSTEM BREAK DOWN WHILE I AM
AWAY, I AUTHORIZE A TECHNICIAN FROM PROTECTION ONE AND A
SECURITY GUARD TO ENTER MY HOME AND MAKE THE NECESSARY
REPAIRS AT NO COST TO ME.
______________________
SIGNATURE
______________________
PRINT NAME