RECEIPT FOR PARTIAL PAYMENT OF RENT
AND AGREEMENT TO PAY BALANCE
Landlord and Tenant agree that the amount of $___________________ has been paid to
the Landlord by the Tenant on the ______ day of __________________, 20_____.
Both Tenant and Landlord agree that there is a balance due in rent for the month of
_____________________20_____ in the amount of $__________________ for the
premises located at and known as ________________________________________.
The parties agree that the balance shall be paid as follows:
1. The amount of $_____________ shall be paid on the ___________________ day
of 20_____, in the form of a cashier’s check or money order.
2. The amount of $_____________ shall be paid on the ___________________ day
of 20_____ in the form of a cashier’s check or money order.
_____________________________ ________________________________
Authorized Agent for Landlord Resident
Address:_________________________
City/State/Zip:____________________
________________________________
Resident
Address:_________________________
City/State/Zip:____________________