Rent Guarantee Payout Request Form

Please fill out the Rent Guarantee Program Payment Request Form and submit the request packet to Rent Well. Landlords must file the request within 30 days from the date the Guarantee expires and/or the date the landlord takes back possession of the unit from the tenant, whichever occurs first. The Guarantee is available for a maximum of $5000.00 in reimbursement for eligible expenses. The request packet must include:

Accounting Statement reflecting tenant-owed expenses
Copy of the Move-Out Condition/Inspection Report
Receipts or invoices for any repairs if requesting reimbursement for damages (if repairs are done by in-house staff, then documentation of time spent and hourly rate is required)
Documentation of non-payment of rent (72 hour notices, tenant ledger, etc.) if requesting reimbursement for non-payment of rent
Receipts for any eviction related court costs, if applicable
Satisfaction of judgment form, if applicable

Property Information

The Property Manager/Landlord/Owner's Name:

Property Name:

Mailing Address:

Telephone Number:

Email address:

Payout Request Information

Tenant(s) Name:

Address They Are Moving Into:

County:

What date did the Property Manager take possession of the unit:

Reason for Payout Request:

Total Amount of Charges Due:

Total Amount of Prepaid Deposits, Rent, or Fees Paid by the Tenant:

Payout Total Amount Requested:

I certify that this information is true and correct to the best of my knowledge. I understand that Transition Projects, Rent Well, and the Oregon Housing and Community Services reserve the right to inspect the unit. By submitting the Request Form I agree that (a) I will not seek a recoupment of costs from any tenant for which this claim is submitted, (b) if an action has already been filed against a tenant, I will file a satisfaction of judgment after receipt of payment from Transition Projects to ensure that I do not receive a duplicate payment for reimbursed costs and expenses. To the extent that I receive a payment pursuant to this Request Form for expenses which have already been satisfied, I agree to repay Transition Projects any over-payment received, or Transition Projects may offset the amount received pursuant to their request by any amounts I have already received.

Your Name:

Date:

If available that this time and needed for this payout request, please upload copies of the following:
Accounting Statement:
Move-Out Condition Report:
Receipts or Invoices for Any Repairs:
Documentation of Non-Payment of Rent:
Receipts for any Eviction Related Court Costs:
Satisfication of Judgment Form:

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Rent Guarantee Payout Request

Rent Guarantee Payout Request Form

Property Information

Payout Request Information