Eviction Intake Form
Name of Tenant
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Property Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Unit number
Property Types
Studio Rooms
Single House
Condo
Townhouse
Multi-Homes
Vacation Homes
Cabin type
How many Tenants are there in the property?
Reason(s) for Eviction?
Rent Collection problems (Late payments or None Payments)
Lease Violation (smoking, vandalism, keeping illegal animals, sub letting)
Tenants Committing Felony
Multiple Noise Complaints
Damage to Property
Was there an eviction notice?
Please Select
Yes
No
How many days notice?
Please Select
3 days
5 days
7 days
10 days
15 days
1 month
Rental agreement type and important details
Is there a Security Deposit?
Please Select
Yes
No
Security Deposit Amount ($)
Last payment made by Tenant?
How many months past due?
Past Due Amount
Landlord Signature
Date Signed
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: