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V5 : ONE-TIME PARTIAL 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 Owner/Agent’s acceptance of partial rent for this rental period does not waive Owner/Agent’s right to terminate for nonpayment of Rent. Owner/Agent may terminate the tenancy for nonpayment of Rent based on a termination notice (which may be served simultaneously, subsequently or prior to the agreed upon payment date).

Total Rent Owed:

0.00

Late Charge:

0.00

Other:

0.00

Other:

0.00

Other:

0.00

Less Payment Made Today:

0.00

Total To Be Paid:

0.00

Tenant(s) agrees to pay balance due of

0.00

by this date and time:

mm/dd/yyyy hh:mm am/pm

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

V5 : ONE-TIME PARTIAL PAYMENT AGREEMENT

Rev.4/16

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