Landlord Reference
Landlord Name
Phone Number
-
Area Code
Phone Number
Email
Address of property rented
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Tenant Name
Duration of tenancy
Less than 6 months
6 months
More than 6 months
Number of times tenant paid rent late
Zero
1
2
3 or more
Did Tenant provide notice before leaving
Yes
No
Did Tenant leave property in a good state?
Yes
No
Please disclose any information which may assist us in deciding whether to rent to this tenant.
Signature
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