Late Rent Request

Name:
Phone:
Date: / /
Email:
Current Address:
Address
CSZ
I am requesting that my grace period for rent payment be extended to the / /
because of the following circumstances:
I understand that the late rent request must be turned into the office at least 2 business days prior to the 1st of the month or late fees will be charged.

I understand that if my outstanding balance is not received in full by 4:00 pm on that day I will be charged full late fees at $5.00 per day retroactive to the first of the month until my entire balance is paid in full. I also understand that by turning in this request it does not automatically guarantee acceptance. Management will notify me within 1 business day of their decision to accept or reject this request.

I am also aware a late rent request will only be accepted once in a six month period with the possibility of waived late fees.
Electronic Signature and Acceptance
If you are electronically submitting this form to Coldwell Banker First Realtors, apply your electronic signature to this form by checking the Electronic Signature and Acceptance box above. By doing so, you hereby consent and agree that your use of a key pad, mouse, or other device to check the Electronic Signature and Acceptance box constitutes your signature, acceptance, and agreement as if actually signed by you in writing and has the same force and effect as a signature affixed by hand.
Tenant Date / /