Damage Dispute Form

Damage Dispute Form
Your name
First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Property address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Please select the charge(s) you are disputing
Pest treatmentsOdor treatmentsTrash removalCleaningFlooring repair/replaceFurniture repair/replaceBathroom repair/replaceDoor/window repairPaint/wall/trim repairOther
Reason for dispute
Damage was present upon move inI disagree with the amount being charged for the damageThe damaged item/unit was not damagedThe charged damage(s) was being shared with neighborOther
Upload a file/photo for any damage that was present upon move-in
Cancelof
Please upload any documentation you have to support your dispute
Cancelof
Please select the charge(s) you claim full or partial responsibility for
Pest treatmentsOdor treatmentsTrash removalCleaningFlooring repair/replaceFurniture repair/replaceBathroom repair/replaceDoor/window repairPaint/wall/trim repairOther
Specify the charge(s) you claim fully or partially in detail
By signing below you aqree with the following
- You are aware of the damages listed above and take full responsibility for your share of those costs.
- You are aware that you will be required to pay the associated charges for cleaning and/or repair to any damage.
- Signing this form does not guarantee that the charges will be waived, nor does it guarantee that the responsibility will be shifted to another individual.
- Submitting this form only serves as your Statement of Dissent and/or your attestation to your damage charges.
- You certify that all of the information provided in this submission (or any other accompanying or required documents) is correct, accurate and complete to the best of your knowledge.
- By signing this completed form, this submission will serve as your formal Statement of Dissent and/or attestation for the responsibility of damage to your unit.
Signature
Clear
Should be Empty: