Wainwright Real Estate Criteria For Rental Applicants Page 6

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LANDLORD VERIFICATION
Please fill out the following information to be used for a rental reference.
Name and address of Landlord:
Date:
_________________________________________
Fax#:
_________________________________________
_________________________________________
Prospective Tenant’s Name:
This information will be used to qualify the prospective tenant for rental housing. I hereby authorize the
release of my rental reference to Wainwright Real Estate.
_____________________________________________
Signature of Tenant
Date
_____________________________________________
______________________
Property Manager
Phone #
Please fax back to 757-495-1563. Your prompt assistance is appreciated.
To be filled out by the Landlord:
Lease Start Date: _______________ Lease End Date: _________________Rent amount:$____________
Was the Tenant ever late on their rent? ____________If yes number of times:
______ ______
Any NSF checks in the last 12 months? _____________If yes how many times? ______________
___
Did the tenant give proper notice for vacating? ______________________________________________
Would you rent to the tenant again? _______________Any legal action ever taken? ________________
Are you aware of any time when the police have been called to the resident’s premises? _____________
Additional Comments:
_______________________________
________________________________ ____________
_
Landlord’s Signature
Landlord’s Printed Name
Date
__________________________
____________________________
__________
___
Phone #
Fax #
Email

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