Landlord ____________________ Address ________________________
Agent _______________________ Address ________________________
**************************************************************
Tenant(s)_____________________________________________________
Tenancy Address ___________________Apt# Tel # _____________
Current Address ____________________________ Tel# ____________
Place of Business__________________________Tel# ______________
Guarantor _______________________Address _____________________
Bank Accounts_________________________________________________
MONTHLY RENT $_______________ DUE FROM ____________TO_________
DAMAGES $ ______________PAINTING________________ MISC ________
(Attach copies of bills)
Security $ ______________Attach cover & signature pages of lease & renewal(s)
LEGAL COSTS $ ________________ Attach eviction papers if any
MOVE OUT DATE ________________ Re-Rental Date ________________
S.S.#/ COMMENTS ______________________________________________
______________________________________________________________
Please include copy of credit ap, credit report, checks, breakdown
sheet and all other information which you feel may be helpful to us.
by : _________________________ Date of Referral ______________
Signature/Title
Your Tel # (____) ____________________
Arrears History
Bldg. _________________ Apt _______
Month ____________________ 200_
$ ________________
Month ____________________ 200_
$ ________________
Month ____________________ 200_
$ ________________
Month ____________________ 200_
$ ________________
Month ____________________ 200_
$ ________________
Month ____________________ 200_
$ ________________
Total
$ ________________
Security - $ ________________
Total
$ ________________
Legal Fees $ ________________
Damages $ ________________
Total to Date $ ________________
If lease hasn't expired, please let us know when the apartment or space
is re-rented. Please complete all forms, and include all available data.