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You are here: Home >>Report Landlord Form

Report Landlord / Manager Form


	Your privacy is secure. By reporting a landlord or apartment manager, your personal contact details will remain confidential and never made public. Please fill out the form as accurately as possible.

General Questions

Are you currently renting from the Landlord in question?	Yes No
Do you have a written contract with the landlord?	Yes No
Have you contacted the Landlord / Manager about the problem?	Yes No

Rental / Renter Information

^*Name: (separate multiple names with comma)	Relationship:
^* Rental Street Address: (If applicable; include apartment #)	^*City:	^*State:	^*Zip Code:
^*Current Mailing Address Same as Rental Address	^*City:	^*State:	^*Zip Code:

^* Primary Phone:
(xxx)xxx-xxxx

Secondary Phone:
(xxx)xxx-xxxx

Email:
(Kept Private / no spam)

Fax:
(optional – not needed)


# of People in Rental?: (numbers only)	# of Bedrooms: (numbers only)	# of Bathrooms: (numbers only)	Rental Amount [$]:	Deposit Amount [$]:

Landlord / Manager Information

^* Landlord / Manager Name: (Separate Multiple Names with Comma)	Business/ Apartment Complex Name (if Available / Applicable)
^*Business Mailing Address: (Typically Where Rents Are Mailed / Include Suite)	^*City:	^*State:	^*Zip Code:
Check this box if there is an additional contact such as: Owner, Property Management Company, Corporate Office, Collection Agency, etc.

^*Primary Phone:
(xxx)xxx-xxxx

Secondary Phone:
(xxx)xxx-xxxx

Email:
(Kept Private / no spam)

Fax Number:
(optional , not needed)

Complaint Details

^*Reason for Filing :	^*Complaint Severity:	^* Title of Complaint: (e.g: Loud Neighbors,Breach of Agreement)
		0 /75 Maximum limit is 75 Characters
^*Problem Ongoing?:	^*Are You at Fault?:	^*Has Landlord Attempted to Resolve the Problem?:


^* What is Your Purposed Resolution? (Create up to 5 specific requests. i.e: 1. Refund $300 Deposit, 2. Reimburse for RPA® Fees, etc.) 1. Add another 5.
Additional Details Pertaining to This Complaint. (Provide details specific to this complaint. Avoid allegations, hostile tone or lists of other problems that aren’t applicable)
0 /2500 Maximum limit is 2500 Characters ( Once the complaint is filed, other details, pictures, letters, etc can be added to your case.)
OPTIONAL Private Message to Mediation Agent (This section is ONLY if you need to relay some confidential information to the RPA Agent.)
0 /500	Maximum limit is 500 Characters

I authorize the Rental Protection Agency to review this report. I further certify that the information has been completed accurately to the best of my knowledge. (By clicking on the box you are digitally signing this release authorization: Your IP Address is: 38.107.179.242)