Landlord Customer Number*Landlord Customer Name*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Last 4 of Social Security Number*Please list all property addresses that need to be added to the landlord rollover program. 1. Property Address*1. Account Number*2. Property Address2. Account Number3. Property Address3. Account Number4. Property Address4. Account Number5. Property Address5. Account Number6. Property Address6. Account NumberWould you like the above property addresses automatically transferred into your name when a tenant moves out?*YesNoThere will be a non-refundable service charge added to the first bill each time the account rolls over into your name. It is the landlord’s responsibility to cancel the rollover agreement when the property has been sold to avoid any future billing activity on the account.
