Landlord Tenant Agreement Claim Form - Invoice For Damages Repaired
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1EXAMPLE
LANDLORD TENANT AGREEMENT CLAIM
INVOICE FOR DAMAGES REPAIRED
DATE OF INVOICE: ____________________________________
ADDRESS WHERE WORK DONE: _________________________________________
APT: _______
Up
Down
Front
Rear
CASE NAME: ____________________________________ CASE #: _______________
MOVE OUT DATE: _____________________________
CONTRACTOR NAME: _______________________________________
CONTRACTOR PHONE #: ______________________
CONTRACTOR ADDRESS: ____________________________________
OWNER / AGENT NAME ______________________________________
VENDOR # ___________ PHONE _________________
Please show # of items repaired per room
U
K
B
H
L
D
B
B
B
B
O
LABOR
LABOR
MATERIAL
TOTAL
N
I
A
A
I
I
E
E
E
E
T
HOURS
RATE
COST
I
T
T
L
V
N
D
D
D
D
H
(ATTACH
T
C
H
L
I
I
R
R
R
R
E
DETAILED
DESCRIPTION OF REPAIRS
H
R
S
N
N
O
O
O
O
R
RECEIPTS)
(Please give details of repairs or replacements for each item)
E
E
O
G
G
O
O
O
O
N
N
O
R
R
M
M
M
M
R
T
M
O
O
O
R
S
O
O
1
2
3
4
O
Y
M
M
M
LOCKS
DOORS
WINDOWS
SCREENS
LIGHTS
RAILING/STAIRS
WALLS
CEILING
FLOOR
COUNTERTOPS
CABINETS
CLOSETS
STOVE
REFRIGERATOR
FAN/EXHAUST HOOD
DISHWASHER
SINK
FAUCET
DISPOSAL
DRAPES/RODS/BLINDS
TUB/SHOWER
TILE/GROUT
TOWEL BAR
TISSUE HOLDER
SMOKE DETECTORS
OTHER
OWNER'S SIGNATURE:___________________________________________
CONTRACTOR'S SIGNATURE: __________________________
*** DOCUMENT IS NOT VALID UNLESS BOTH SIGNATURES ARE PRESENT ***
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Parent category: Business