Partial Payment Agreement

Partial Payment Agreement
Email (PM)
example@example.com
Date of Submission
Date

MonthDayYear
Date

Tenant Information
Name*

First NameLast Name
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com

Landlord Information (PM Company)
Landlord Name OR Company*
Full Title
Payment plan due on:

MonthDayYear
Date

Payment Details
You are required to pull your total current balance directly from your ledger in the tenant portal.
Click here to go to your tenant portal.
Please note that upon approval of your Partial Payment Agreement, all agreed upon payments must still be submitted via your tenant portal. Payments do not enroll in autopay upon agreement approval.
Total Balance Owed As of TODAY:*
Only use decimals if a cent amount is owed.
How many installments will you be paying in total? MAX OF 4*
You may choose between 1 and 4 installments.
First installment amount:*
First installment to be paid on:*

MonthDayYear
Must be within 60 days of today.
Second installment amount:*
Second installment to be paid on:*

MonthDayYear
Must be within 60 days of today.
Third installment amount:*
Third installment to be paid on:*

MonthDayYear
Must be within 60 days of today.
Fourth installment amount:*
Fourth installment to be paid on:*

MonthDayYear
Must be within 60 days of today.
Total Amount:

Partial Payment Agreement
Sorry, your payments don't add up to your overdue balance. Please try again.
In consideration of my unpaid rent as of {typeA49}, I, {name} (Tenant), promise to pay Keller Williams Realty Phoenix (Landlord/Property Manager) my unpaid balance in the amount of ${unpaidBalance} within 60 days of submission, payable as follows:

The amount of ${unpaidBalance} shall be paid by {paymentPlan} in {howMany} installments and will be applied towards past due balance of utility charges. (Tenant shall pay via certified Funds or online via tenant portal.)

I understand and agree that the "Landlord" does not waive its rights under the law or the Rental Agreement. I re-affirm my agreement to pay all future rent not later than the first (1st) of each month.

I also understand and agree that I am currently in default of my Rental Agreement.

I understand that my failure to make any of the above stated payments on the past due rent owed will constitute a default of this Partial Payment Non-Waiver Agreement. I understand that I am subject to a Judgement (if no Judgement has been entered) and the premises is subject to a lock-out through a Writ of Constitutuon without further notification by the Landlord of this matter has already proceeded to Judgement.

Furthermore, I understand that, in consideration for being allowed to make a partial payment, this agreement shall be deemed the five-day notice requirement of ARS § 33-1368, receipt of which is hereby acknowledged. I understand I will be liable for late fees, attorney fees, court costs, lease break fees and rental concessions.
Tenant Signature*

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Tenant Signed On

MonthDayYear
Date
Should be Empty: