Landlord-tenant referral form

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Landlord-tenant dispute referral form

Your e-mail * Tenant name * Tenant address * Tenant phone * Landlord name * Landlord address * Landlord phone * Date of inspection (mm/dd/yyyy) CODE VIOLATIONS ONLYDate referred CODE VIOLATIONS ONLY (mm/dd/yyyy)The Landlord-Tenant Relations Program is looking for referrals in the following three free service areas. Which type of referral are you requesting (check all that apply)?

Landlord-tenant mediation servicesCode violation referralTenant referral (to appropriate resources for your housing concerns)Briefly explain why you are requesting our services* denotes required field

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NOTE: A request for mediation services is not a guarantee. Both parties must agree to mediation before services can be rendered.

If you encounter difficulty with this form or have questions about submitting a referral request, please call 704-336-5330 or e-mail Terry Bradley.

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