Security Deposit Dispute Form
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1Security Deposit Dispute Form
Name:
Contact #:
_______________________________________
(________)_______________________
Previous Address:__________________________________________________
Unit address
Apt #
City
State
Zip
Mailing Address:___________________________________________________
Address
Apt #
City
State
Zip
Please check all that apply, and then please detail below why you would like us to review the
charge(s):
Amount of Deposit
Amount of Non-Refundable Fees
Unpaid rent Charges/Credits
Late Fee Charges
Court Cost Charges
Keys Not Returned Charge
Cleaning Charges
Carpet Cleaning Charges
Carpet Repair Charges
Carpet Replacement Charges
Drapery Charges
Repair Charges
Yard Maintenance Charges
Hauling/Dump Charges
Painting Charges
Utility Charges
Smoke Detector Tampering Fee
Pet Violation Fee
Treat for fleas/pests Charges
__________________________
__________________________
__________________________
__________________________
__________________________
Please list in detail what the dispute is about:
________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Please attach additional pages and information if necessary
Emerald Property Management, Inc. Ο 525 Harlow Road, Springfield, OR 97477 Ο (541)741-4676 Ο (541) 744-2849
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Parent category: Business