Late Fee Tracker Form

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First Name *

Enter the tenant's first name who is responsible for paying the late fee. If co-tenants list first tenant of record.

Last Name *

Enter the tenant's last name who is responsible for paying the late fee. If co-tenants list first tenant of record.

Building Address *

Enter the building address of the tenant of record (not the apartment #)

Apartment # *

Enter the apartment # of the tenant of record.

E-mail Address

Enter the e-mail address of the tenant of record.

Phone number *

Enter best contact phone number of the tenant of record.

How did you pay the rent (the amount in dispute?) *

Rent Drop Box

Postal Mail

Via Online Banking

On what date did you make your payment? *

Be precise.

Which Month(s) is (are) allegedly "Past Due"? *

How much was the late fee? *

How much is your monthly rent? *

Did you ultimately ending up paying the late fee *

(Answer no if it was refunded or rescinded)

Yes

Comments

Enter any additional comments that might help us understand your situation.

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