Resources

First Name

Last Name

Phone #

Address

Apt #

Best time to reach you

What caused the problem initially

When did it start

What room is the problem located in

How does one gain access to the apartment to do repairs

Do you have a pet, that must be considered before entering the apartment No Yes

Please list the name and telephone # of all tenants living in the apartment:

It is understood that the form listed above is by no means considered notice to the landlord if there is a problem in the building. This feature is to be used as solely a courtesy to help you in the process of resolving a potential issue. Under no circumstance will Destination Real Estate or the owner recognize the items listed above on this form as proper notice of an issue. Neither Destination Real Estate nor the owner is responsible to act on any of the information listed. By submitting this information, I am attesting that I have full power and take full responsibility to grant permission for the issues above. I give permission for this issue is to be attended to by any means of the landlord and/or Destination Real Estate if consulted or seen fit. I can personally attest that I have the right to speak on behalf of myself and all of my roommates (if applicable). Furthermore, I grant full access to anyone of authority to fix the problems listed above and under no circumstance will I hold anyone but myself accountable for any incident thereto. I also agree to keep any pets that I may have in a concealed and safe place, making it impossible for my pet to cause harm to me, my roommates (if applicable), any personal items, and anyone who may enter the apartment in attempt to fix the said problem. I will be held fully responsible to account for any and all personal items. I take full responsibility for my pet's actions and at no time will I attempt to take action in any way, shape, size, or form against the landlord or anyone else who enters the apartment.