Request Eviction

Referred By

Eviction Type *

Non-Payment Holdover Other

Please Specify

Your Information

Your Name *

Company

Phone Number

Email Address *

Street Address

City

State/Province/Region

Postal/Zip Code

Tenant Information

Tenant Name *

Street Address

City

State/Province/Region

Postal/Zip Code

Credit Card Information

Name on Card

Card Number

Expiry

Lease Information

Is the lease oral or written?

Oral Written

Copy of Lease

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Date Lease Began

Date Tenant Moved In

Date Lease Expires

Notices

Has 30 Day Notice Been Served? *

Yes No

If So, When?

Copy of 30 Day Notice

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Cancel

Has 3 Day Notice Been Served? *

Yes No

If So, When?

Copy of 3 Day Notice

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Rent & Fees

Monthly Rent Amount *

Late Fee Amount *

Subsidized Housing? *

Yes No

If so, who is the subsidizing agency?

Please Note: You MUST tell us if it is Section 8 or the court WILL DISMISS

Tenant Portion

Subsidy Portion

Months & Amounts Due

Total Amount Due *

Are you willing to enter into payment arrangements with the tenant? *

Yes No

If so, under what conditions?

Supporting Documents

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Request Eviction

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