License Agreement Fee and Security Deposit

The Philadelphia Land Bank requires a Licensing Fee ($50) and Security Deposit ($500) for each individual License Agreement. Separate License Agreements may be required for survey and Geotech work if developers are using different contractors for each. This includes Scopes of work for the following: Survey, GeoTech, and /or Test Pit Digging.

Complete the form and payment below for each individual scope of work. All fields are required.

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Business Name *

Primary Contact Name *

First

Last

Address *

Address Line 1

Address Line 2

City

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Zip Code

Email *

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Phone *

Parcel Addresses Included in Scope of Work: *

Scope of Work *

• Survey
• GeoTech or Test Pit
• Other:

List Other

Terms
Total of $550.00 per License Agreement
In consideration of the issuance of the License agreement, the Licensee shall pay the Land Bank a fee in the amount of Fifty and 00/100 Dollars ($50.00) (the “License Fee”).

Deposit Amount *

Deposit Amounts for License Agreements in the amount of five hundred fifty dollars ($550.00) may be paid through this PayPal link.

Minimum Price: $550.00

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