Application Requirements

    I, , am requesting a refund of the application fee and/or deposit I paid on (date), because at the time I paid the application fee and or deposit, the unit I was applying for had already been rented or there were qualified applicants ahead of me who have been or will be approved for the unit.

    Amount paid (attach copy of receipt or bank statement)

    Information About Landlord/Rental Unit

    Information About Refund Requestor

    Additional Information (Required)