RESIDENT VERIFICATION FORM (MANAGEMENT CROSS-CHECK) 


Resident _____________________ 
Address  _____________________ 
Date     _____________________


1. During 20 , I occupied my residence from to 
. 
2. My original deposit was in the amount $ . 

3. Has any amount been deducted from your deposit? yes 
no. If so, how much? $ Why? .
4. My application fee was $ refundable 
non-refundable 
.
5. Were there any other move in fees? If so, what? .
refundable non-refundable 
.
6. Did you receive a move-in special? yes no. 

7. Describe the move-in special, bonus, discount, or gift you
were given! 
.
8. My normal monthly rent is $ . 

9. I pay late fees when applicable in the amount of $ . 

10. If so, how often? How much? .

11. Have you paid any late charges or additional rent this year? 
January February March April 
May June July August 
September October November December.

12. I pay my rent with Cash Checks. 

13. My Payments are mailed dropped off or picked up by . 
14. Do you have receipts? yes no. 

15. Do you pay for any utilities? yes no. 

16. If so, which ones .

17. Have you been requested to pay any extra charges this year for bounced check additional/special service.

18. Have you received a referral fee or extra tenant bonus of any kind this year? yes no 

19. If so, how much $ and for what . 

20. Have you received satisfactory service this year? yes no.

21. If not, what is one thing we have neglected to do?