☐
☐
City:_______________________________
☐
AgentName&Company:_____________________________________________________________________
Address:______________________________________________________________________
Registration:$100PerRentalUnit
Inspection:$75PerRentalBiAnnual
Biannualrentalswillbecontactedforappointments.
NEWRENTAL:$75Inspection
NewRentalRequiresInspection.
BiannualInspectionrequiredforcurrentrentals.
ContactOfficeforNEWInspectionAppointments.
One(1)trashunitisincludedintaxes,anyadditional
unitsarebilled@$165foreachadditionalunit.
Paybleto:BoroughofConshohocken
400 Fayette Street,Suite200
Conshohocken,PA19428
Phone:610.828.1092
Fax 610.828.0920
Iattestthatallinformationaboveisaccurate.
OwnerSignature:_______________________________________
Date:_________________________
PrintName:_______________________________________
OfficialUseBelow
☐
Even☐Odd☐NewRental☐Remove/Change☐ Updated ☐_____________ ☐
Owner'sMailingAddress:(allrequired)
Street:________________________________________________________________________
POBoxesarenotaccepted
Tenant/Tenant'sName
&Phone#
#ofpeople&Check(√)
appropriatebox
Unit
#14yrsor
younger
#Over
age14
#
Handicap
REQUIREDIFYOULIVE
FURTHERTHAN12MILES.If
youareusinganagent,all
fieldsarerequired.
PropertyAddress:_____________________________________________________
CurrentRental
Owner'sName:________________________________________________________
NewRental
Doyouliveonsitethisrental
Owner'sphone#:__________________24HourPhone/Cell:___________________________
Email:_________________________________________________
City:_________________________________State:______________Zip:__________________
Phone#________________________________AfterHoursPhone#:______________________________
Note:Pleasefill inthehandicapboxifyoufeelthatpersonwouldneedassistanceinanemergency.
exp
date
Inspection
Email:____________________________________________
BOROUGH OF CONSHOHOCKEN
400 Fayette Street, Suite 200 • Conshohocken, PA
19428 Phone (610) 828-1092 Fax (610) 828-0920
RENTAL PROPERTY REGISTRATION