Valleyfield Homeowners Association, Inc.


Member Pool Card Key Receipt Form


This form serves as a receipt for each memberís new pool card key. Each homeowner is entitled to one key, programmed based on their homeís address in the community. Loss or damage of this card will require member to purchase a new card for a fee of $5.00. Please report all lost or stolen cards to the VHOA Board of Directors as soon as possible to ensure card is not used by unauthorized personnel. Signing this form, members agree to continue to abide by all VHOA documents including the Declaration of Covenants, Conditions, Restrictions, and Easements, and the associated Community Bylaws. Non-compliance with these documents or failure to pay your quarterly dues can result in loss of access to the pool and other community activities as stated in Article 6.4 of the Declaration. [Article 6.4: If the violation is the nonpayment of any general or special assessment, the Association shall have the right to suspend the offending Ownerís voting rights and the use by such Owner, his agents, employees and invitees of the Common Areas in the Subdivision for any period during which an assessment against the Lot remains unpaid.]


Memberís Name (Print):__________________________________________

Memberís Signature:_____________________________________________

Memberís Street Address:_________________________________________

Todayís date:___________________

Lost Key _____†† $5.00††††††††††††††††††††††††† New Key ______


If you are in compliance with the VHOA documents and current on your homeownerís dues, please fill out and sign this form. Forms should be dropped off in the mailbox on the pool's main gate unless this is a lost key application. We will then be distributing the pool card keys to each homeowner as soon as we can after we are in receipt of your form.Please allow 5-7 business days for your key. Please make every effort to return this form as soon as possible. Thank you for your support.


Please remit $5.00 payment for lost key to Valleyfield at


Carolina Property Associates

1140 Holly Springs Rd.

Holly Springs, NC 27540

Phone: (919) 521-5394