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Rental Information Agreement

  1. City of Westbrook Rental Information Agreement
    (This form must be completed in its entirety.)
    Notice to Landlord: The City of Westbrook’S Code Enforcement Department will now be inspecting all housing units prior to the general assistance office authorizing payment on an applicant’s behalf.

    Please provide complete and accurate contact information so that the inspection can be set up and completed in a timely manner.
  2. Landlord Information
  3. Unit Manager Information
    If other than above.
  4. Apartment Information
  5. Is a security deposit required?
    If the City pays a security deposit, the entire deposit must be returned to the City of Westbrook within 21 days (or within a 30-day window, if lease indicates a 30-day security deposit return) after the tenant moves out indicating amount being returned. (A security deposit cannot be kept for “normal wear and tear”.)
  6. What utilities are included in the rent?
  7. How is the unit heated?
  8. Is the listed tenant occupying this unit?
  9. Is handicap access required for anyone in this household?
  10. Any Relationship to tenant?
  11. I certify that the above-referenced unit has been inspected and there are no deficiencies:
  12. Notice:
    This Rental Information Agreement is not intended to imply that the prospective tenant is either eligible for assistance or that they will necessarily be renting an apartment from you. All rental payments are made directly to the Landlord, not the tenant. Applicants receive a written decision stating whether or not assistance has been granted. A purchase order is provided for the landlord.

    City of Westbrook General Assistance phone is 207-854-0676, ext. 5280.
  13. Leave This Blank:

  14. This field is not part of the form submission.