Request to port (Relocate)

PORTABILITY TRANSFER REQUEST
Head Of Household*
Number:*
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
New Housing Authority Information

Please provide the following information on the new Housing Authority you wish to transfer to under your portability option
Name Of Housing Authority
Address

Street Address

Street Address Line 2

CityState

Zip Code
Contact Person:
Email
example@example.com
Phone Number

Area CodePhone Number
Fax Number

Area CodePhone Number
Note:

A minimum of ten (10) days is necessary to process your file and mail it to the receiving HousingAuthority.
Tenant's Signature

Clear
Enter your signature here
Date

MonthDayYear
Housing Authority Only:
Request Has Been:

ApprovedDisapproved
Date Faxed:

MonthDayYear
Date Mailed

MonthDayYear
Housing Authority Signature

Clear
Housing Authority Approved/Declined Date

MonthDayYear
Should be Empty:

PORTABILITY TRANSFER REQUEST