Landlord Application

To enroll, you must agree to the terms listed below.

1. Be in good standing with the County and State of Texas;
2. Provide a valid and complete W9;
3. Provide an accurate and current detailed rent roll or roster of tenants eligible for the program;
4. Agree to accept rent payment directly from the County, and charge no penalties, late fees or any other consequential fees; and
5. Agree to refrain from initiating any eviction process for the month(s) the tenant has applied for assistance or to rescind any such process that is underway.

NOTE: Rental payments made under the program will not exceed $2,000 a month.

I agree to terms above. *   

Full Company Name *

Contact Person

If different from company name.

Email *

Phone *

Company Street Address *

City *

State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip *

Mailing Address

Same as Company Address? *   

Street Address

City

State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

Are you aware of or have you received rental assistance payments from any state or local government program on behalf of the tenant? *
Yes
No

Provide details on the assistance you have received

Rental Properties

Method of Payment *
ACH
Mailed Check

Bank Name

Account Number

Routing Number

By checking the following agreement and submitting this online form, I/WE, THE UNDERSIGNED, HEREBY CERTIFY AND ATTEST TO THE FACT THAT ALL OF THE INFORMATION I HAVE PROVIDED ABOVE IS ACCURATE AND NOT FALSELY PROVIDED. FALSELY PROVIDED INFORMATION WILL RESULTE IN REJECTION OF THE APPLICATION AND DENIAL OF ANY PARTICIPATION IN THE PROGRAM. FALSIFYING INFORMATION MAY ALSO RESULT IN PROSECUTION FOR VIOLATION OF FEDERAL LAW FOR MISSTATING, MISREPRESENTING ANY SUCH INFORMATION PER TITLE 18 U.S.C § 1001 (FALSE STATEMENTS, CONCEALMENT).

I/we understand that the information submitted will be verified prior to approval.

I agree to the terms and conditions. *   

Electronic Signature (full name) *