PERSONAL INFORMATION:
First Name:
Street Address:
Unit/Apt:
Floor:
Last Name:  
Number of Bedrooms:
Lease Year:
Email Address:  
Roommates:  
Phone:  
All Roommates know of issue?
YES       NO
PROPERTY MANAGER:
Company Name:
Street Address (optional):
Phone (optional):  
Date contacted:  
Name of office staff (optional):
Contact documented?
YES       NO
Was contact in person, email or phone?  
Has anything been done by management or maintenance to correct the issue?
YES       NO
Have you allowed Management time to correct issue?
YES       NO
If yes, how much time have they taken to correct issue?  
Brief Description of issue (be very specific):
What do you suggest to resolve this issue?