Opt Out Form - City of Campbell - Rental

Opt Out Form (Withdraw Form) - City of Campbell Below Market Rate (BMR) Rental Program

PLEASE READ THIS FORM COMPLETELY BEFORE SUBMITTING IT.

If you would like to Opt Out and withdraw your Drawing/Lottery Rental Opportunity Submission Form and/or your interest for a particular property please follow these steps:

Read and review all the information on this form before you fill it out.
Fill out this Opt Out Form (Withdraw Form) completely
Submit Form in agreement with all the applicants in your household.
WARNING: Once this form is submitted, your priority/ranking/runner up numbers (for the Opportunity Drawing you indicate) will be null and void immediately.

By filling out this form, you may still keep and use your Application ID to submit/participate in future opportunities.

Today's date*

1. Application ID Number*

For BMR Rentals in Campbell

2. BMR Priority/Ranking Number*

If one has not been assigned, type "0"

3. Please select the Drawing/Lottery Rental Opportunity Number that you want to Opt Out of (withdraw from):*

4. How many applicants in the household?*

Household Membel 1*

First Name

Last Name

Household Membel 1 Phone Number*

Household Membel 1 Email*

Household Member 2 Name

First Name

Last Name

Household Member 2- Email

Household Member 3 Name

First Name

Last Name

5. Are you withdrawing from all the properties associated the Drawing/Lottery Rental Opportunity ID you selected on this form?*

I/we opt out (withdraw) from all the properties in this drawing/lottery (if one or more is available)

If you opt out of this Drawing/Lottery Rental Opportunity, you can still use your application ID Number for future opportunities.

6. If you are opting out/withdrawing from a specific property, please enter the address.

If you don't enter an address, you are indicating that you are opting out of all the properties associated with the Opportunity you indicated on this form.

7. Why did you decide to opt out/withdraw?*

8. Are all Applicant(s) and Co-Applicants in agreement with the information entered on this Opt Out Form? (All must be in agreement before submitting this form)*

Applicant Signature*

[clear]

Use your mouse or finger to draw your signature above

Co-Applicant Signature (if not applicable- please print "not applicable")*

[clear]

Use your mouse or finger to draw your signature above

Additional Co-Applicant Signature (if not applicable- please print "not applicable")*

[clear]

Use your mouse or finger to draw your signature above