Landlord-Tenant Contact Form

In the United States, people are entitled to be treated fairly when they are trying to rent a place to live, without regard to their race, color, national origin, religion, sex, familial status, or handicap (disability). Title VIII of the Civil Rights Act of 1968 (Fair Housing Act) guarantees protections against discrimination in housing. If you have been discriminated against in your search for housing, contact an experienced real estate attorney today to discuss your rights.

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Landlord-Tenant Contact Form

*First Name

*Last Name

*Email Address

*Phone Number


Street Address


Incident Street Address

Incident Apt/Ste

*Incident Zip

Business Phone

Cellular or Pager

If you are representing a business or property owner, what is their name?

Business address


What type of business is it? (Sole proprietorship, LLC, etc.)

Have you used any other personal or business name(s) in the last six years?
Yes  No 

If yes, please list here

Who else can we call if we cannot reach you?

Contact's name

Contact's telephone numbers



What is the address of the rental property in question?





Are you presently living at this address?
Yes  No 

If not, what dates did you reside there

When living there, which did you have - a lease agreement (generally agreements for six months to one year) or a rental agreement (generally month-to-month arrangements)?

When you signed the lease or rental agreement, were you working with a real estate agent or rental agency service?
Yes  No 

If yes, please provide the name and contact information of the person or company you were working with



Telephone number

What problem or issue are you having/were you having with your rental housing (check all that apply)?

security deposit
unsafe dwelling
lease termination

Please describe the nature of the problem

On what dates did the problem(s) occur? Please be as specific as possible

If you are a tenant, what contact have you had with the landlord or property owner regarding this matter? Include information on dates of and type of contact (i.e. telephone call, letter), if known

What was the response of the landlord or property owner?

If you are the landlord, what contact have you had with the tenant regarding this matter?

What was the response of the tenant?

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