Rental History Verification Form
Property Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Tenant Name
First Name
Last Name
Dates of Occupancy From
-
Month
-
Day
Year
Date
To
-
Month
-
Day
Year
Date
Did you give the applicant a notice to vacate?
Yes
No
Please explain
How many times during the past 12 months did the applicant pay late?
Does applicant currently have any delinquent amounts owing?
Yes
No
Have there been any neighbor complaints?
Yes
No
How many?
Has there been any police activity?
Yes
No
Please explain
Did Applicant make any unauthorized repairs or alterations?
Yes
No
Did Applicant move in any unauthorized adult occupants?
Yes
No
Did Applicant damage any part of the property?
Yes
No
Please explain
Additional Comments
Name
First Name
Last Name
Title
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Date
-
Month
-
Day
Year
Date
Signature
Submit
Should be Empty: