DIRECT DEBIT APPLICATION

EFFECTIVE APRIL 2004, ALL NEW RESIDENTS ARE REQUIRED TO PAY THEIR QUARTERLY ASSESSMENT BY DIRECT DEBIT.

AUTHORIZATION FOR DIRECT PAYMENT OF CURRENT MAINTENANCE FEE DUE AND ANY SCHEDULED SPECIAL ASSESSMENTS.

Your payments will be made automatically on the specified day, the third of the month or the next business day. And proof of payment will appear with your statement. If the amount of your payment changes, we will notify you at least 10 days before payment date.

I authorize Wentworth Property Management of NJ and the financial institution named below to initiate entries to my checking/savings account. I understand that if an item is returned, I will be responsible to pay a return item fee.

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(Name of Financial Institution/Homeowner Bank Name) (Branch)

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(City) (State) (Zip Code)

Bank Account No._____________________________ Routing Number__________________________

Savings account or Checking account: __________________________________________________

A VOIDED CHECK FROM YOUR CHECKING ACCOUNT MUST ACCOMPANY THIS APPLICATION.

ASSOCIATION NAME: SHADOW LAKE VILLAGE

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(Homeowner Street Address of unit owned - Please Print)

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(Homeowner City) (Homeowner State) (Homeowner Zip)

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(Homeowner Signature’s) (Homeowner Name - Please Print) (Date)

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(Homeowner Signature’s) (Homeowner Name - Please Print) (Date)

This form MUST be received by the Wentworth accounting department no later than the 10th of the month preceding activation of service. Mail your completed form to: Wentworth Property Management of NJ, 100 Highway 36 East, Suite 1A, West Long Branch, NJ 07764-1455 Attention: Direct Debit. A CONFIRMATION LETTER WILL BE SENT TO YOU ADVISING THE START DATE OF FIRST WITHDRAWAL OF DUES.