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V4 : ONE-TIME LATE PAYMENT AGREEMENT

Required entries are indicated by blue icons or *

Tenant(s)* (required)

Tenant(s)

et al (and all others)

Property Address* (required)

Unit #

City (Oregon ONLY)

OREGON Zip Code

Tenant(s) agree(s) that the total rent due shall be paid on

Date (mm/dd/yyyy)

FOR THIS MONTH ONLY.

RENT DUE:

0.00

LATE CHARGE:

0.00

BALANCE DUE:

0.00

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



Tenant	Date	Tenant	Date

Tenant	Date	Tenant	Date

Tenant	Date	Tenant	Date


Owner/Agent Signature:			Date:

MAKE PAYMENTS TO:

Owner/Agent

Address

City

State

Zip

Telephone

Owner/Agent may terminate the tenancy for nonpayment of Rent based on a termination notice. Such notice may be served prior to the agreed upon payment date.

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

V4 : ONE-TIME LATE PAYMENT AGREEMENT

Rev.4/16

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