WYO HELP Landlord Form

WYO HELP Landlord Form

To be completed by the landlord only.
This is not a form for Tenants. Completing this form by the tenant will not result in receiving assistance. This form is to be completed by the landlord after the tenant has registered for assistance. No assistance can be provided until the tenant has registered, provided the required documents, been verified as qualifying based on income, and the landlord completes this form.
Tenant Information

This is the person requesting assistance
Name of Tenant to be credited with Payment*

First NameLast Name
Address of Tenant Rental*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Home for Tenant*
Date Rent was (is) due for Tenant*

MonthDayYear
Date
Amount Due From Tenant to make due one month in advance of regular due date.*
Be sure to include any late fees.
Landlord Information

This must be completed by the landlord and contain the landlord information to be accepted.
The limit per household is $1,000 for all payment services from October 1st - September 30th The amount provided to the tenant will be restricted to $1,000 for the year including all payment assistance received.*

I am willing to accept $1,000 and make payment arrangements if the amount due exceeds $1,000. I am also willing to discuss a lower amount if the household has already received payment services.I am NOT willing to accept less than the amount due and understand that may mean my tenant does not receive payment assistance.The amount due is under $1,000
Name of Payee for Check*
Landlord, Property Manager
Address to send check (Cannot be the same address as the Tenant)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Landlord or Property Manager Contact Name*

First NameLast Name
Landlord or Property Manager Phone Number*

Area CodePhone Number
Landlord or Property Manager Email
Providing your email allows us to better communicate payment status.
Landlord or Property Manager Tax ID (EIN or Social Security Number) Required by IRS to provide 1099.*
Sent via encrypted form.
Copy of lease or statement

Browse Files

Cancelof
County where the Tenant lives*
Consent

By checking this box, I agree to receive payment from WYO HELP on behalf of my tenant. I agree that if the amount listed on this form is paid that it will move their next due date one month in advance of their regular due date.
Signature of Landlord.*

Clear
Please note that your information will be encrypted and only accessible by the end user with a password. Processing typically takes 1 week once all required documents are received and tenant has been confirmed as qualified. Please note that mailed payments have been taking up to 2 weeks to arrive.

WYO HELP is a Wyoming registered nonprofit under the name Goshen HELP, 1933 Main Street, Torrington Wyoming. Our phone number is 307-532-0269. Email is intake@wyohelp.com.
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WYO HELP Landlord Form

Tenant Information

Landlord Information