Rental History Sample Form
VERIFICATION OF RENTAL HISTORY
The above identified person applied for residence at ________________________________________,
and has indicated to us that you now have (or recently had) this person or family as a tenant in your
property located at:
As indicated by this person(s) signature on form attached, the tenant consents to the release of
information pertaining to their rental history at your property. We would greatly appreciate your
cooperation in completing the applicable areas below.
Please Answer The Following Questions Regarding The Tenant(s) Rental History:
1. How long has or had the above tenant resided at this address?
2. Did the tenant enter into a lease?
3. Did the tenant fulfill the lease terms?
4. What is or was the monthly rental?
5. Has the tenant ever been late in payment of the monthly rent?
If yes, number of times?
6. Dose the tenant owe any past due or current charges?
If yes, what is the amount?
7. What type of damages, if any, has the tenant caused in the unit or on common property?
8. Was the tenant been charged for any damages to the unit?
If yes, what is the amount? Did the tenant pay the amount?
9. Has any action ever been taken against the tenant for disturbing other tenants, or
controlling the behavior of children or guess?
If yes, what type of action?
How many times?
10. If this tenant moved and reapplied for housing in the future, would you rent to him/her
If no, why?
11. Additional Comments:
Signature: Title: Date:
If you have any questions please call _____________________________