Address:
City:
Zip:
Current Owner(s):
Name:
Entity:
Email:
Telephone Number:
How should FCCSA deliver the Resale Certificate? (one must be selected below) *FCCSA will provide within three(7) to ten(10) business days of receipt of request and fee*
—Please choose an option—Mail to Property Address ** FEDEX/UPS Return Label REQUIRED **Mail to Requesting Party's Address (must be completed above) ** FEDEX/UPS Return Label REQUIRED **Mail to Other Address (**provide address below) ** FEDEX/UPS Return Label REQUIRED **Requesting Party will pick up at FCCSA Office (FCCSA will call the telephone number included with Requesting party info above when available for pick up)
**Other Address:
$250.00 TRANSFER FEE WILL BE DUE AT CLOSING (REFER TO STATEMENT OF ACCOUNT) to request a SOA email acctg@firstcolony.org
Credit Card: MasterCardVisaDiscoverAmex Transaction Fee: $8.25
Amount:
Card Number:
Exp Date:
Security Code:
Phone:
Signature:
Date:
* By checking this box the Entity/ Contact Person acknowledges that the information is true and correct. Applicants providing payment and personal information must agree to share the information willingly to the FCCSA and trust the information will be treated with respect and is kept confidential. Information is used only for the "Lot Coverage Form" and by no means makes the First Colony Community Services Association responsible for additional debt or liability of the applicant.