Manufactured Housing Communities of Oregon 3857 Wolverine Street N.E., Suite 22 Salem, Oregon 97305 (503) 391-4496  FAX (503) 391-4652 Please fill out this form, print and mail or fax to MHCW. Each community/park must carry its own membership. Multiple community/park owners should maintain a membership for each community/park.	MHCO Membership Application Form MHCO Forms Ordering MHCO Forms Descriptions Service and Industry Membership Application back to main Forms page

Community Information

Community Name

Physical Address

City      State   AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    Zip

County

Telephone Number     Fax

E-mail

Manager's Name or Property Management Firm

Address if different from above

Number of Spaces: Permanent     LongTerm RVs      ShortTerm RVs

Community Classification (Check one):   Family/All Age   55+  62 & over

Community Amenities & Information (Check all that apply):   Rec Room  Pool  Laundry Room  Septic  Satellite/Cable TV  City Water  City Sewer  Well Water  Playground  RV Storage  Guest Parking  Storage Shed  Other (Please explain)   Average Space Rent:  $ mo. Average Age of Homes: Year Park Built: Rent Increase Amounts: 2002 $ 2006 $ 2003 $ 2007 $ 2004 $ 2008 $ 2005 $   Utilities Paid By: (for multiple selections, hold the Ctrl or Shift key while clicking the mouse) Resident None Water Sewer Electric Cable Garbage Landlord None Water Sewer Electric Cable Garbage

Community Business Information

Billing Address:

Attention:

City      State   AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    Zip

Telephone Number     Fax

E-mail

Community Owner Information

Name(s)   County

Mailing Address

City      State   AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    Zip

Telephone Number     Fax   E-mail

Membership dues cover mailings to ONE ADDRESS ONLY. Please place a large asterisk * next to the one address where all literature/notices are to be sent.

As a member you are entitled to one (1) vote in all MHCO elections. Please print the name of the person designated to exercise this voting privilege.

MEMBERSHIP DUES  Dues $8.00 per space X   spaces *Minimum dues is $150 for communities having fewer than 20 spaces. $ Initiation Fee (New Member fee of $75) $ TOTAL AMOUNT REMITTED = $   Send to: MHCO, 3857 Wolverine St. N.E., Suite 22, Salem, OR 97305

Method of Payment

Check or Money Order	Note: Payment must be received before membership will be active.
Credit Card Choose One Visa MasterCard   Exp. Date Card #	Card Billing Address   Signature on Card
Send Completed Application (and payment by check, money order or provide credit card information) to: MHCO at 3857 Wolverine St. N.E., Suite 22, Salem, OR 97305 or Fax Completed Application to: (503) 391-4652. A signature is required if faxing.

Signature if Faxing:

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