Security Deposit Agreement - Health Planning Council Of Southwest printable pdf download

Security Deposit Agreement - Health Planning Council Of Southwest

SECURITY DEPOSIT AGREEMENT

NOTE: THIS FORM MUST BE FILLED OUT COMPLETELY IN ORDER TO BE PROCESSED FOR PAYMENT.

This is to verify that _________________________________________ has applied to rent an apartment located

at____________________________________________________________________________. The rent is

$________________ per________ (

). The security deposit is $_____________ .

month or week

If this individual is eligible for assistance, I agree to accept a check from The Health Planning Council of

Southwest Florida, Inc to cover the security deposit. I understand that payment will be received within 30 days

of the date on the request. I understand that any balance due on the security deposit after the authorized

amount has been paid by The Health Planning Council of Southwest Florida, Inc remains the responsibility of

the tenant. Further

, I agree to return any unused portion of the deposit to The Health Planning Council of

Southwest Florida, Inc.

Please print clearly:

Make check payable to:__________________________________________________________________________

Address for check to be sent: _____________________________________________________________________

__________________________________________________________________________________________

Name of Landlord:______________________________________________________________________________

Phone Number: _________________________

Fax Number: _____________________________________

Signature: _____________________________ Date: ___________________________________________

Title:__________________________________

Tax ID # or Social Security#:________________________

FOR OFFICE USE ONLY

AUTHORIZED AMOUNT: Security Deposit$_____________________________

Signature:

Date:

Security Deposit Agreement - Health Planning Council Of Southwest