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FORM #29 - One Time Partial Payment Agreement

  • Tenant(s):
  • Tenant(s):
  • Address: Unit:
  • City: , OREGON Zip:

Tenant(s) agree(s) that Owner/Agent’s acceptance of partial rent for this rental period does not waive Owner/Agent’s right to terminate for non-payment of rent. Owner/Agent may terminate the tenancy for non-payment of rent based on a termination notice (which may be served simultaneously, subsequently or prior to the agreed upon payment date)..

  • Total Rent Owed: $ ________________
  • Late Charge: $ ________________
  • Other: $ ________________
  • Other: $ ________________
  • Other: $ ________________
  • Less Payment Made Today: $ ________________
  • Total To Be Paid: $ ________________

Tenant(s) agrees to pay balance due of $ ______________ by _______________

Owner/Agent Signature: ___________________________ Date: __________________

  • Owner/Agent:
  • Address:
  • City: , State: Zip:
  • Telephone: Email:

Owner/Agent does not waive the right to terminate by simultaneously or subsequently served notices.


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1462 Commercial St. NE, Salem, OR 97301
Phone: 503-364-5468 | Fax: 503-585-8119

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