a. If rent is paid by the month --
What is the monthly rent?
Write amount here $ ____________.00 (Nearest dollar)
and Fill one circle

[] Less than $30
[] $30 to $39
[] $40 to $49
[] $50 to $59
[] $60 to $69
[] $70 to $79
[] $80 to $89
[] $90 to $99
[] $100 to $119
[] $120 to $149
[] $150 to $199
[] $200 to $249
[] $250 to $299
[] $300 or more

"If you pay rent by the month, write in the amount of rent and fill one circle."

b. If rent is not paid by the month -

What is the rent, and what period of time does it cover?
$ ____________.00 per ______________________________
(Nearest dollar) (Week, half-month, year, etc.)