Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Rental Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date Occupied (Begin)

MM

DD

YYYY

Date Occupied (End)

MM

DD

YYYY

Release of information digital signature (type name)

type your name as consent to use digital signature

First Name

Last Name

Date

MM

DD

YYYY

Lease Term (From)

MM

DD

YYYY

Lease Term (To)

MM

DD

YYYY

Obligations fulfilled?

Yes

No

Would you rent to this tenant again?

Yes

No

Were payments timely?

Yes

No

Is tenant released from lease?

Yes

No

Was proper notice given

Yes

No

Does the tenant currently owe you money?

Yes

No

Date completed

MM

DD

YYYY