Housing Provider Reference (PDF)

Use this fillable PDF to gather housing references from a prospective tenant’s previous landlord(s).

This fillable PDF template includes:

• Applicant’s signature authorization to contact and collect information from previous housing providers
• Editable text to add your email and/or fax number to form.
• Fillable fields for previous housing providers to complete, including length of residence, rent payment history, vacate notice, complaints, damage, and more.

TIP: Have your prospective tenant complete and sign their section of this form electronically so that the fillable fields stay in place for the landlord to easily complete and send back.

What’s inside:

APPLICANT AUTHORIZATION

HOUSING PROVIDER FIELDS

Full address of premises rented

Length of residence Move-in / Move Out

Rent payment history

• Payment always on time
• Payment sometimes late: _____ Number of times late
• Payment always late

Was proper vacate notice given?

• Yes
• No

Were there problems with housekeeping or complaints from neighbors? If yes, please explain.

• Yes
• No

Was there any tenant damage to the residence? If yes, please explain.

• Yes
• No

Do you recommend this person as a tenant? If yes, please explain.

• Yes
• No

Contact information for authorized personnel completing this reference.