(Office)540.578.4974
(fax) 540.908.3633
contact@ChoosePriority.com
www.ChoosePriority.com
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Priority Property Management LLC • 737 E. Market Street, Harrisonburg, VA 22801 • Licensed in Virginia
LANDLORD REFERENCE REQUEST FORM
Hello Management/Landlord;
The Tenant(s) named above have applied with PPM for a rental unit and have authorized disclosure of information.
We understand you have previously rented or are currently) renting to them at:
Please furnish the following information as applicable and return by fax, email, mail or in person. We cannot consider
this form valid if delivered by the tenants themselves.
1. When did the Tenant rent from you? From To
2. Rent amount during last month of tenancy? Were any utilities included?
3. Rent was received more than 5 days late times (Please indicate 0 or number of times)
4. Any property damages or lease violations at any time during tenancy? Yes No If yes, for what reason(s)?
5. Did/will the Tenant receive the full security deposit refund? Yes No N/A (Pending Move-Out)
6. Have you ever received any complaints from neighbors of Tenant? Yes No If yes, what kind?
7. Has Tenant completed the lease term? Yes No Given official notice? Yes No
8. Was Tenant asked to vacate by Landlord, Agent, or Court Order? Yes No If yes, for what reasons(s)?
9. Is Tenant current with all lease payments and any outstanding fees? Yes No
10. Are you related to Tenant by family or marriage? Yes No
11. Did/Does Tenant(s) have any pets? Yes No How many & what kind/size?
12. Would you lease to Tenant again? Yes No
13. Add any more comments or concerns:
Signed by Authorized Manager, Landlord, or Agent Responding
Print Name Date
TENANT’S AUTHORIZATION PURSUANT TO VIRGINIA CODE 55-248.9:1
I authorize the free and complete release of all information about my tenancy at ANY rental unit, and agree to hold
harmless anyone who so responds in good faith. A copy/fax of this authorization shall be accepted as if original.
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Name of Applicant Signature of Applicant Date
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Name of Applicant Signature of Applicant Date
