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2. OWNER INFORMATION
4. Owner Name*
5. Business Name
7. Owner Mailing Address*
9. Business Phone Number*
10. Evening Phone Number
12. Owner Email Address*
16. PROPERTY MANAGER OR AGENT INFORMATION (if different from property owner)
18. Name
19. Business Name
21. Mailing Address
23. Business Phone Number
24. Evening Phone Number
26. Email address
30. RENTAL PROPERTY INFORMATION
32. Rental Property Address*
33. Property ID Number*
34. Year Built*
36. Type of Rental*

    Check box that applies

    1. Single Unit

    1. Multi-Unit (2+ units)
38. Number of Units (total)*
39. Number of Units
40. with ____bedroom(s)
42. Number of Units
43. with ___bedroom(s)
44. Number of Units
45. with ___bedroom(s)
47. Example:

    Number of units (total):  30      Number of units  20 with  2 bedroom(s);   Number of units 10 with 1 bedroom(s), etc.

49. Comment(s)/Questions:
53. APPLICANT AFFIDAVIT

    I hereby attest to the truth and accuracy of the information contained in this application.

55. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
57. Electronic Signature
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit Submit and Print

* indicates a required field