Complete Your Custom ORHA Rental Form

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Required entries are indicated by blue icons or *

et al (and all others)

This is a reminder that your rent is past due.

Your past-due rent amount is: 
You will be assessed a late charge of:  
according to the terms of your rental/lease agreement.

If the rent remains unpaid, further action may be taken
under ORS 105 to return possession of the rental unit to the Owner/Agent.

If you are on a Fixed-term Lease, be advised your Landlord has the option to terminate your tenancy at the End of your Lease if you have received three or more Notices for Noncompliance (including Nonpayment of Rent) within a 12-month period preceding the End of the Fixed-term. Owner/Agent may terminate the tenancy by issuing a 90-Day Notice prior to the Lease End Date, or 90 days prior to the date designated in the Notice, whichever is later. Correcting the third or subsequent violation is not a defense to the termination.
This is your
violation in the last 12 months.

Please Note: Signature field must be filled in and signed after printing.

Owner/Agent Signature:   Date:


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PO Box 20862, Keizer, OR 97307
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