Complete Your Custom ORHA Rental Form

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Owner/Agent has received the sum of
, which will be applied to amounts due at move-in.
Monthly Rent to be

(payable in advance)
Move-in Date:

If Fixed Term is checked, lease will end on:


Security Deposit
Other Deposit
1st Month's Rent
Minus Deposit to Hold
Total Due at Move-In


Tenant is also required to maintain minimum of $100,000 liability coverage and add Owner/Agent as Interested Party. If Tenant(s) combined household income falls at or below 50% of the median for the area, Renter’s Insurance may not be required.
The current Fees are:
Tenant(s) are solely responsible for the Fees charged by the Postmaster for the re-keying of the box should a key not be provided by the Owner/Agent, or if the mail box has not be re-keyed between tenancies.
After assessment of Monthly Charge, Tenant(s) shall have 30 days to pay the charge in full. Failure to pay the utility charge by due date shall result in a $50 Noncompliance Fee upon a 2nd or subsequent violation within one year of issuance of Written Warning Notice.
In Addition, the Owner/Agent may charge the following Noncompliance Fees:
  • Late Payment of Rent Charge of
  • Smoke alarm and carbon monoxide alarm Tampering Fee of $250.00.
  • Dishonored Check Fee of $35.00 plus amount charged by bank.
  • Early termination of lease Fee not to exceed 1-1/2 times the Monthly Rent, or Actual Damages at option of Owner/Agent
  • Owner/Agent may charge the following:
    Noncompliance Fees after first giving a Written Warning Notice of initial violation if noncompliance occurs within one year: $50.00 fee for 2nd violation, and $50 plus 5% of current Rent for each subsequent violation.
     1. Failure to clean up pet waste, garbage, rubbish or other waste fee. 2. Parking violation or other improper use of vehicle Fee.
  • Owner/Agent may charge a Fee for keeping on the premises an unauthorized pet capable of causing damage, that is not removed within 48 hours of Written Warning Notice. Fee not to exceed $250 per violation.
  • Owner/Agent may charge a Fee for smoking/vaping in a clearly designated non-smoking/vaping unit or area of the property. Fee may be assessed for repeat violations that occur as early as 24 hours after the Effective Date of a Written Warning Notice, and for each subsequent violation within one year. Fee not to exceed $250 per violation.


It is agreed that Tenant(s) shall pay the balance of funds due by the date the property is to be occupied, and sign a Rental/Lease Agreement. If the unit has not been viewed by the Applicant prior to lease up, dissatisfaction with the unit type, condition or location is not cause for refund of the Deposit-to-Hold.

Owner/Agent is charging this Deposit for the purpose of securing the execution of a Rental Agreement after having approved the Application and prior to entering into a Rental Agreement. If a Rental Agreement is executed, the Owner/Agent shall apply the Deposit toward the Funds Due under the Rental Agreement. If a Rental Agreement is not executed due to a failure by the Applicant to comply with this Agreement, the Owner/Agent may retain the Deposit in full. If a Rental Agreement is not executed due to a failure by the Owner/Agent to comply with this Agreement within four (4) days the Owner/Agent shall return the Deposit to the Applicant either at the place of business or by mailing the Deposit by First Class Mail to the Applicant. Proof of timely compliance with this requirement shall include a postmark. Refund of the Deposit-to-Hold amounts tendered is the sole remedy for Owner/Agent failure to deliver the unit when agreed.


Please Note: Signature fields must be filled in and signed by all parties after printing.

Applicant Date   Applicant Date
Applicant Date   Applicant Date
Owner/Agent Date   Owner/Agent Date

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PO Box 20862, Keizer, OR 97307
eMail: office@oregonrentalhousing.com