LANDLORD/TENANT CLAIM FORM

TO:  MARYLOU PAOLUCCI & ASSOCIATES, P.C.
16 Trent Lane
Smithtown, NY 11787
Phone# 631-863-ATTY (2889)
Fax# 631-265-8982
Email: attycollect@optonline.net 

Please commence immediate suit on the usual 25% contingent fee terms:

YOUR COMPANY NAME:

Full Legal Corporate Name:  

(including any d/b/a (doing business as)  or trade names)

Company Contact:  

Address:  

Phone, Email & Fax:  

TENANT INFORMATION:

Account Number:  

Full Name of Tenant:  

Last Known address on File:  

Date Lease signed:  

Monthly Rent:  

Months Rent owed:  

Date vacated:  

Additional Charges:  

Total Due:  

Brief summary of what took place:  

PLEASE MAIL OR FAX IF AVAILABLE:

  • Copy of Lease

  • Any credit application

  • Any written agreement

  • Statement of Account

  • Any prior checks received

  • Any other information / any dispute

 

You will have an opportunity to print a copy of this form upon submission.
Please commence immediate suit on the usual 25% contingent fee terms.

 
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Validation Code:

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MARYLOU PAOLUCCI & ASSOCIATES, P.C.
THE CONTINGENCY LAWYERS
16 TRENT LANE, SMITHTOWN, NY 11787
Phone: (631) 863-ATTY (2889)
Fax: (631) 265-8982
Email: ATTYcollect@optonline.net 
Website: www.ATTYcollect.com

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