Rental Application LANDLORD

Rental Assistance - Landlord

To be completed and submitted by the landlord.
Client First Name*
Client Last Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I understand that the client named above is applying for housing assistance through Eblen Charities. The funds being requested are for (please check):*

Deposit fundsFirst Month's RentPast Due Rent or Mortgage

Upon signature, the landlord agrees to accept $ amount* on behalf of named client to help the client avoid eviction; or to be able to take possession of the rental unit. Their monthly rental costs are $ rental amount* and I agree to accept $ amount* to maintain their housing for the next 30 days. The original amount was due on date*
Landlord Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Landlord Signature*

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Date*

MonthDayYear
Date
Request for Taxpayer Identification Number and Certification
If you have not submitted a W-9 to Eblen Charities in the last 12 months you must complete this section.
Department of the Treasury Internal Revenue Service

Go to www.irs.gov/FormW9 for instructions and the latest information.

Give form to the requester. Do not send to the IRS.

Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.
1 Name of entity/individual. An entry is required. For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregarded entity’s name on line 2*
2 Business name/disregarded entity name, if different from above.
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes.

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):
on page 3.

Individual/sole proprietorC corporationS corporationPartnershipTrust/estateLLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership)
Exempt payee code (if any)
Note: Check the “LLC” box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner.
Exemption from Foreign Account Tax Compliance Act (FATCA) reporting
code (if any)
Print or type.

Other (see instructions)Other (see instructions)
3b If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC” and entered “P” as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions Specific Instructions
(Applies to accounts maintained outside the United States
Address*

5 Address number, street, and apt. or suite no See instructions. See

Street Address Line 2

6 City, state, and ZIP codeState / Province

Postal / Zip Code
Requester’s name and address (optional)
7 List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN If you do not have a number, see How to get a TIN, later.
Social security number
Employer identification number
Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter.
Certification
Sign Here*
Date*

MonthDayYear
Date
Should be Empty:

Rental Assistance - Landlord

Request for Taxpayer Identification Number and Certification

Part I

Taxpayer Identification Number (TIN)

Certification