Rent Distress Assignment Form

Carpe.ca

Please fill in this form and submit it to our office by clicking the SUBMIT button on completion, or by Printing and Faxing. Please use the TAB button to move to the next test box. DO NOT use the return key, as this will submit the form prior to completion. If you require assistance, please contact us at 604 590-3548

Please fill in this form and submit it to our office by clicking on the

E-mail Address:   * Must be a valid E-mail address

 

Regarding the commercial property at:

Name and Address of Landlord:

Name
Address
City
Province/State
Postal Code/Zip  
Country
Telephone

Name and Address of Tenant ( as it appears on lease ):

Name
Address
City
Province/State
Postal Code/Zip  
Country
Telephone


Outstanding amounts:   ( How much to they owe? )

What does this amount consist of?      ( Rent, taxes, common area costs, utilities etc. )

Is there a lease in place?  Yes   No 

Was there a lease in place?  Yes    No    If yes, what was the expiry date? 

Does the lease require you to give notice?  Yes    No 

Is rental month to month?  Yes    No 

Have you collected any monies this month?  Yes    No    If so, how much? 

Who should we contact for landlord instructions or reports?

Name
Address
City
Province/State
Country
Telephone
Fax
Date

Special Instructions:


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Revised: 09/01/07.