Association Information Qualifier Worksheet

Please provide the following information about your Association to request your complementary meeting with a Deficit Funding Representative.

Name *

First

Last *

Last

Email *

Phone *

Position with Association *

Name of Association *

Total # of Units/Homes in Association *

Assessment/Maintenance Information *

Total Annual Budget Amount *

Are you self-managed or managed? *

If managed, please provide the following

Company Name

Manager Name

Confidentiality Clause: Deficit Funding agrees that it will not disclose or permit the disclosure of any Confidential Information to any person, firm or entity, or use or permit the use of any Confidential Information received. Recipient further agrees to exercise a high degree of care in protecting the Confidential Information which is comparable with that which Recipient utilizes in protecting their own information.