PBV Application Form 2 of 5 - Landlord Verification - Roanoke-Chowan Regional Housing Authority

PBV Application Form 2 of 5 - Landlord Verification

RCRHNC Logo.

Roanoke Chowan Regional Housing Authority
8:30 am - 5:00 pm Monday-Thursday
8:00 am - 11:30 am Friday
Except Holidays
205 Tinsley Way, Gaston, NC 27832
252.537.1051

Fields marked with * must be completed or form will not submit.

For non-applicable fields enter N/A.

Date

Name of Applicant*

Applicant's Street*

Applicant's City*

Applicant's State*

Applicant's Zip*

Agency Name

Landlord's Name*

Landlord's Street*

Landlord's City*

Landlord's State*

Landlord's Zip*

Applicant Signature*

The person named above has applied for a rental assistance at Roanoke Chowan Regional Housing Authority.

He/She has authorized us to request information relating to residency or assistance with you/your agency. Please answer the following questions below and return as soon as possible.

Thank you for your cooperation.

Move in Date

1. Has rent been paid on time?

2. Monthly rent amount $

Were utilities included in rent?

3. Have you had any problems with this tenant?

If answer is yes, please note any problems

Agency/Landlord Signature