Landlord Verification Form

Landlord Verification Form
Date

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
RE: Applicant Name*

First NameLast Name
Due Date:*

MonthDayYear
Date
Address of Unit Rented*

Street Address

Apt/Unit Number

CityState

Zip Code
Name of Landlord*

First NameLast Name
Are you a relative or friend of the applicant?*

YesNo
Describe Relationship*
Are you a*

Current LandlordPrevious LandlordOther
Dates of Applicant's Tenancy: From Date* to Date*
Does/did the applicant have a lease?*

YesNo
Rent Payment
Amount of Monthly Rent*
Does/did the applicant pay rent on time?*

YesNo
Has/had they ever paid rent late?*

YesNo
How late?*
How often?*
Have/had you ever begun/completed eviction for non-payment?*

YesNo
Was a court judgement rendered in your favor for eviction for non-payment?*

YesNo
Do/did you provide any of the utilities?*

YesNo
Have/had tenant paid utilities ever been disconnected?*

YesNo
Caring for the Unit
Does/did the applicant keep the unit clean, safe, and sanitary?*

YesNo
Has/had the applicant damaged the unit?*

YesNo
How often?*
Cost of Repair*
Has the applicant paid for the damages?*

YesNo
Describe*

0/275
Will/did you keep any of the security deposit?*

YesNo
Explain*

0/275
Does/did the applicant have problems with insect/rodent infestation?*

YesNo
Does/did the applicant's housekeeping contribute to the infestation?*

YesNo
Explain*

0/275
Did the applicant make any alterations to the unit without your permission?*

YesNo
Explain*

0/275
General
Is/was the applicant listed on the lease for the unit?*

YesNo
Does/did the applicant permit persons other than those on the lease to live in or stay in the unit on a regular basis?*

YesNo
Explain*

0/275
Has/had the applicant, family members, or guests damaged or vandalized the common areas?*

YesNo
Explain*

0/275
Does/did the applicant, family members, or guests create any physical hazards to the unit or other tenants?*

YesNo
Explain*

0/275
Does/did the applicant, family members, or guests interfere with the rights and quiet enjoyment of other tenants?*

YesNo
Explain*

0/275
Has/had the applicant, family members, or guests engaged in any criminal activity, including drug-related criminal activity?*

YesNo
Explain*

0/275
Has/had the applicant given you any false information?*

YesNo
Explain*

0/275
Has/had the applicant, family members, or guests acted in a physically violent and/or verbally abusive manner toward neighbors, landlord, or landlord's staff?*

YesNo
Explain*

0/275
Would you rent to this applicant again?*

YesNo
Why or why not?*

0/275
By signing this form, I certify that the information given is true and complete to the besy of my knowledge.
Signature*

Clear
Date*

MonthDayYear
Date
Printed Name*

First NameLast Name
Should be Empty:

Landlord Verification Form

Rent Payment

Caring for the Unit

General