Oil City Housing Authority

PA: Oil City Housing Authority - Tenant Charges

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Note: A service fee of $2.50 or 2.95% (whichever is greater) will be assessed for this payment and will appear on the next page. VISA, MasterCard and Discover cards are accepted. If you do not agree to these terms, please click CANCEL below and make different payment arrangements. VISA, MasterCard and Discover cards are accepted.

Tenant First Name*

Tenant Last Name*

Tenant Address (number and street)*

Apartment/Unit Number (if unknown, enter 'N/A')*

Phone Number*

Phone Area Code-Phone 3-Phone 4 ext Extension

E-mail Address

Rent Payment Amount (if this does not apply, enter $0.00)*

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Washer/Dryer Payment Amount (if this does not apply, enter $0.00)*

Air Conditioning Payment Amount (if this does not apply, enter $0.00)*

Security Deposity Payment Amount (if this does not apply, enter $0.00)*

Pet Deposit Payment Amount (if this does not apply, enter $0.00)*

Other (not listed aboved) Payment Amount (if this does not apply, enter $0.00)*

if OTHER was selected as the payment type, enter a description

Note: The Service Fee is non-refundable.

Note: To continue, please click CHECKOUT below. Provide your e-mail address on the next page to receive an e-mailed receipt from this transaction!

By continuing to the Checkout, entering my method of payment and completing the transaction, I authorize OCHA to process my payment based on my selected method of choice (debit card, credit card, e-check) to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated, and is valid for one time use only. I certify that I am an authorized account holder of the payment method I have entered and that I will not dispute the payment with my financial institution, so long as the transaction corresponds to the terms indicated on this form.

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PA: Oil City Housing Authority - Tenant Charges

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