LANDLORD REGISTRATION & PAYMENT

ONLINE FORM SUBMISSIONS FOR PERMITS, LICENSES, REGISTRATIONS & OTHERS
(INCLUDING ONLINE PAYMENT WHEN APPLICABLE)

Select the Online Application Form
Attach Associated or Required Documents
Submit the Online Application & Payment (if applicable) in a single submission to the Municipality
Receive Immediate Notification the Online Form & Payment Submission was Received by the Municipality

* Fields in red are required

(Click the link below to display the form. Download, complete, sign, save, and then attach the form to be uploaded along with your online payment submission to the Municipality.)

LANDLORD REGISTRATION FORM

An amended registration statement must be filed within 7 days after any change in the registration information. A separate registration statement must be filled out for each rental unit.

ADDRESS OF DWELLING:

NAME OF OWNER(S) OF RECORD:

ADDRESS:

TELEPHONE NUMBER:

In order to complete your online Landlord Registration with the municipality, please upload and submit the following:

The filled, completed, and signed Landlord Registration form.
Your accompanying online Landlord Registration payment of $150.

Incomplete applications will not be accepted or processed.

REGISTRATIONS ARE NON-REFUNDABLE

ATTACH YOUR COMPLETED & SIGNED MUNICIPALITY LANDLORD REGISTRATION FORM:

ATTACH LANDLORD REGISTRATION FORM :

You hereby certify that the above and included information is correct under penalty of law.

I HEREBY CERTIFY:

Yes No

Payer Information

Billing Name:

Address:

Address 2:

City:

State:

ZIP Code:

Daytime Phone:

Payer E-mail Address:

Payment Information

Payment Amount:
$150 - Registration Fee Per Unit

Payment Method:

Convenience Fee:

Enter information as it appears on your check (USA Banks Only)

Routing Number:

Account Number:

Re-Enter Account #:

Using the following lower portion of a personal check as an example, enter the information that appears at the bottom of your check. Do NOT include any dashes or spaces.

Credit Card:

Convenience Fee:

Credit Card Number:

Sec. Code:
What is the Security Code?.

What is this and why do I have to do it?

Due to the amount of credit card fraud over the internet, banks will soon REQUIRE this information to process credit card orders online - you can expect to see it used everywhere in the very near future. Your benefit is that it prevents any fraudulent charges using your credit card, i.e. no one can pick up an old receipt of yours and use that info to fraudulently use your credit card. Thanks for your cooperation.

American Express
4 digits on front of card

Visa and Mastercard
last 3 digits on back of card

Note: The digits are printed on your card, rather then stamped in the plastic like the digits in your credit card number.

Exp. (Month/Year):
/

(2 digits, Range: 25-35)

Comments:

Terms & Conditions:

These are the "Client’s" Online Payment Terms & Conditions.

Please read the information below before using the Internet to make payments to Your Town municipality. If you agree and want to proceed, please click the "I AGREE!" button at the bottom of the page to continue with the payment process. By continuing this process, you are electronically authorizing this payment transaction.

This online payment process is provided as a convenience by Your Town municipality. For credit card transactions (if applicable), when you choose this payment option you are authorizing the charge to your credit card.

ACH ELECTRONIC-CHECK PAYMENTS

The online ACH electronic-check payment process is provided as a service by Your Town Municipality. When you choose the ACH electronic-check payment process you authorize your bank to directly transfer the amount you specify from your checking account to an account for Your Town municipality.

As always, the responsibility for ensuring that Your Town municipality actually receives payment of the proper amount in a timely fashion remains with the payer. It is up to you to make sure that all of your information is entered correctly and to make sure that money is available in your account to cover the payment transfer. Your Town municipality has authorized a $20.00 charge for each bad check submitted to Your Town municipality.

CREDIT CARD TRANSACTIONS
(CONVENIENCE-FEE APPLIES)

This online payment process is provided as a convenience by Your Town. When you choose the credit card payment option, you are authorizing a charge against your credit card account for the amount of your payment to Your Town municipality, plus a convenience charge based on your designated payment amount. Prior to completing your credit card transaction, the system will calculate and inform you of the convenience fee you will be charged. You then have the option to continue with your payment or cancel out of the transaction.

The convenience fee is collected by Your Town municipality to cover the merchant fees charged by the credit card companies plus the other costs associated with this service. These fees are based upon the amount of your payment to be charged.

Credit card payments can be made using American Express, Discover, Mastercard or Visa.

Payments received after midnight each day will be posted as of the next business day.

It is your responsibility to make sure that all of your information is entered correctly and to make sure you have available credit on your credit card to cover the payment.

Payment Submission Confirmation

After you submit your online payment to Your Town, a Payment Submission Confirmation webpage should display that you should print and save for your records. If a Payment Submission Confirmation webpage does not display after you have successfully submitted your online payment, you should call Your Town Business Office at 123-456-7890.

Terms

Your Town municipality provides the payment pages to allow payments over the Internet solely as a convenience to its club members. Your Town municipality makes no representation, guarantee, or warranty as to the accuracy, truthfulness, completeness, currency, or suitability of any content provided on or linked to the payment pages and specifically disclaims any and all liability for any claim or damage that may result from using the payment pages. By using the payment webpages, you represent that you have read and agree to be bound by these terms.

Privacy

Your Town municipality does not use the information you provide in these payment pages for any purpose other than processing and posting your payment. Your Town municipality does not share this information with any person, entity, or organization that is not a party to the transaction. It does not sell the information you provide. It does not "data mine" the information. Your Town municipality may make the information available to customer service and/or support representatives to facilitate your payment processing and inquiries, however.

Security
Your Town municipality is committed to protecting the confidentiality of your account numbers and the other information that you provide. This payment process employs secure servers and encryption (SSL-128) in communications over the Internet. What that means, simply, is that your information is encrypted / scrambled as it travels across the Internet.

Payer Submitter – please indicate below that you “Agree” to Your Town municipality's payment Terms & Conditions in in order to proceed with the online payment process.

I agree to the above Terms and Conditions.

Your Town, USA

Your Town, USA

LANDLORD REGISTRATION & PAYMENT

Payer Information

Payment Information

Terms & Conditions: