I Client Full Name * acknowledge that the Ark of Refuge is providing a Rental Assistance payment directly to my landlord. I confirm the status of my social and economic circumstances and assert I have been provided these resources in lieu of an emergency. Furthermore, I authorize my landlord to release my personal, and proprietary information to obtain grants funds provided by the Ark of Refuge.

I Staff Full Name * assert that I am the landlord for the above-stated tenant and have been authorized to release tenant information for future payments made on behalf by this organization. To my knowledge all of the above information correct and true. This electronic signature is a Binding agreement between the Landlord, Client, and Ark Of Refuge.