BELL PROPERTIES TENANT REQUEST FORM

Tenant Request for Acommodation
REQUEST FOR PAYMENT PLANS AS A RESULT OF COVID-19, CORONA VIRUS
Name*
First NameLast Name
E-mail*
Phone Number
Area CodePhone Number
Full Property Address
Enter the address on your lease
Are you requesting a payment plan as a result of COVID-19? *
Yes or No
Have you been laid off, been fired, or had your wages reduced as a result of COVID-19? If yes, please explain:
Please explain how you’ve been affected financially

Have you applied for CA Unemployement? If YES, ENTER YOUR CA EDD UNEMPLOYMENT CONFIRMATION NUMBER:
Please explain how you’ve been affected financially

How has the COVID-19 Virus affected your household financially:
Please explain how COVID-19 has affected your finances
Date of change in Employment:*
MonthDayYear
If approved, what would your proposed repayment terms be? How soon would you be able to complete the current payment:?
Please explain how you’ve been affected financially
How much can you pay, per week, until your rent is paid in full?
Please propose your re-payment plan, percentage per week
If other terms, please specify weekly payments, and length of proposed payment plan:
If Other Plan needed, Please propose your repayment terms needed
Should be Empty:

Tenant Request for Acommodation