This is a written rental agreement between __________________________________ (Tenant’s Name)
and _____________________________ (Landlord’s Name)
The Landlord (named above) has verbally agreed to allow the Tenant (named above) to reside at his/her
residence located at:
For the amount of $ _______________ /month beginning ______/______/______ (Move-In Date).
The deposit amount is:
The Tenant is responsible for payment of the following:
None (All Utilities
This written rental agreement carries over from month to month and is validated by the acceptance of the
rent check by the Landlord.
If the Tenant is asked to leave the premises before the complete month is up, the Landlord is required to
return the remainder of the month’s rent to the originator of the rent check (That amount being the total
month’s rent amount divided by the number of days in the exiting month, then multiplied by the number of
days the client was unable to reside at the residence.)
If a check for the rental comes from an originator other than that of the Tenant, this originator is not
responsible for damages caused by the Tenant or back rents owed by the Tenant. If there are damages, the
Landlord is required to provide proper notification with proof of damages to the originator of the rent
check. Submission of proof of damages does not guarantee payment.
The signatures below will validate this agreement between Landlord and Tenant:
Landlord Name (Printed)
Tenant Name (Printed)
Organization Representative Name
Organization Representative Signature