Rental Assistance Information Form

CROSSROADS MINISTRY of ESTES PARK, INC. IS CONSIDERING A RENTAL ASSISTANCE GRANT TO HELP TENENAT LISTED BELOW TO MEET RENTAL OBLIGATIONS.

In order to process the grant, Crossroads of Estes Park requires the information below. This form with affixed signatures must be returned within seven (7) days or it will be null and void. Upon successful and timely completion of this form, Crossroads of Estes Park will write a voucher for the amount of the grant. A check will then be written within 10 working days and either mailed to the address listed below or left in the Crossroads of Estes Park office, as indicated below.

OWNER OR PROPERTY MANAGER INFORMATION

(Name to whom the check should be made out)

First name

Last name

Phone

Mail Payment to: (Name, Street, City)

TENANT INFORMATION

Tenant Name:

Tenant Phone:

Street Address of Rental Unit

Normal Rent: (Amount, How often, Due by)

Is the tenant behind in rent?

Yes

No

If yes, what is the total amount owed?

Will you accept a grant on behalf of the tenant? (NOTE: Tenant is still responsible for paying the remaining balance due)

Yes

No

If you assess late charges, will you forgo them if a grant is given:

Yes

No

Will the tenant be evicted if no payment is made?

Yes

No

Do you prefer the check to be mailed or picked up?

Mail check to address listed above

Pick-up check at Crossroads of Estes Park

Method of Payment

A check will be issued and either mailed to the address provided above or available at Crossroads of Estes Park for pick-up.

Please allow 10 working days to receive check.

By signing this document, you agree to NOT evict the tenant for non-payment of rent, for a minimum of 30 days from the date signed by Property Owner/Manager.

Date

Month

Day

Year

Signature of Property Owner/Manager

Signature field is empty.

Rental Assistance Information Form

Method of Payment

Crossroads Rental Assistance Information Form

Crossroads
Rental Assistance Information Form