Eviction Intake Form

Eviction Details

First Name

Last Name

Email of Client Authorizing Project

Phone Number

Tenant’s Name

List all names of tenants on the lease. If there is no lease, list the names of all adult occupants.

Rental Address

Address Line 1

Address Line 2

City

State

Zip Code

Eviction Reason

Select all that are relevant

Past Due Rent Amount:

Amount that wasn’t paid (if applies).

Lease Violation Reason

If the lease was violated, explain why.

Additional Details

Please provide all necessary details, including past-due rent (if any), lease violations, and information about the tenant we may need to succeed.

Additional Email(s)

Email Address(s) of anyone else who should be contacted with updates/information.

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