Applicant Details

Delinquency Details

Covid-19 Eviction Prevention Program Consent to Release or Obtain Information

I authorize COVID-19 EVICTION PREVENTION PROGRAM (CEPP) to release or obtain the following information:

1. Information about my employment and income
2. Information about my rental history

This information may be used only for the purposes of mediation and/or rental assistance (if applicable)

I confirm that the information provided in my CEPP Information Sheet is true and complete. I understand that providing false or inaccurate information is grounds for rejection of mediation and/or rental assistance (if applicable).

Imperium Property Management & Consulting LLC is providing mediation services. CEPP does not guarantee financial assistance from any resources.

Privacy Policy
CEPP provides this privacy policy to inform you of our policies and procedures regarding the collection, use and disclosure of personal information. For the purposes of this privacy policy, “Personal Information” means information that can be used to uniquely identify you, such as your name and email address.
We mainly use your personal information either alone or in combination with other information so that we can provide, enhance and personalize our services to you. We may collect, use, transfer and disclose information in a form that does not personally identify you (“non-identifying information”) for any purpose.
We will not share your personal information with other companies or individuals outside of CEPP unless we have received your consent. Non-identifying information may be provided to third parties for data collection and research purposes.
We adhere to Fair Housing Laws and guidelines where applicable.

I have read and agree to the terms stated above .
I agree that all of my answers are true and correct to the best of my knowledge.



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Lease Agreement:

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Proof of Income (if applicable):

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Unemployment eligibility (if applicable):

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Positive COVID-19 test result (if applicable):

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