Fillable Uva'S Roommate Agreement Service Form (Page 3 of 5) in pdf

The following tenants will have single bedrooms:

_________________________________ will live in __________________________, $_________;

(name)

(room according to floor plan)

(Rent)

_________________________________ will live in __________________________, $_________;

(name)

(room according to floor plan)

(Rent)

_________________________________ will live in __________________________, $_________;

(name)

(room according to floor plan)

(Rent)

_________________________________ will live in __________________________, $_________;

(name)

(room according to floor plan)

(Rent)

PAYMENT OF RENT

Each roommate shall pay his/her full rent on or before the ____________day of each month. If failure to pay results in a late

charge by the landlord, the person(s) paying their rent late will be responsible for all late charges incurred. If a rent check is

returned for insufficient funds, that roommate is similarly individually responsible for all resulting charges.

If the landlord requires payment by one check, _______________________ (designated roommate) shall be responsible for

making that payment, and all rental payments to him/her must be made by the ______ day of the month (or by the ______ day of

the previous month) to insure timely payment.

Note: If the group sets up a separate house account for payment of rent and bills, individual payments will be deposited into that

account and a check will be written to the landlord or creditor from the account for the full amount.

UTILITIES

The utility bills for the premises include (check all that apply):

___ electric in ____________________________________’s name;

___ gas in _______________________________________’s name;

___ water and sewer in _____________________________’s name;

___ fuel oil in _____________________________________’s name;

___ telephone in __________________________________’s name;

___ firewood in ___________________________________’s name;

___ trash pickup in _________________________________’s name;

___ newspaper in __________________________________’s name;

___ television cable in _______________________________’s name;

___ Internet in _____________________________________’s name;

___other(s)(specify)________________________________________

in_________________________________’s name;

All utility costs (including tax) are to be divided equally among the roommates unless provided otherwise below. Payment of each

person’s share must be made promptly in order to avoid late payment charges. Any roommate(s) whose late payment incurs late

payment charges shall pay all such charges. Special provisions: __________________________________

The base cost of the telephone, plus taxes shall be divided equally among the roommates. Each roommate shall be individually

responsible for all his/her long distance expenditures.

KEYS

There are __ keys available to the roommates from the landlord. __ (#) of copies were made for (list roommates):

______________________________________________________________________________________________________

All keys and copies must be returned to landlord by move-out date, unless otherwise specified. If there is a guest key made, the

roommate whose guest obtains the key is responsible for returning it to a central location: ______________________________.

___ (#) additional copies were made for the purpose of _____________________________ and will be kept by/in___________.

PARKING

There are ___ spaces available to the roommates for parking. If permits are necessary to park, each roommate will be

responsible for obtaining and paying any fees associated with his/her individual parking permit. If parking requires cars to block

each other from entering or exiting, roommates will establish an agreeable method with which to move cars as necessary.

Uva'S Roommate Agreement Service Form Page 3

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