Landlord Partnership Program Assurance Application

* Indicates required field

Property Information

Tenant First Name *

Tenant Last Name *

Unit Address *

ZIP / Postal Code *

Move-in Date *

Move-out Date *

Landlord Information

Landlord First Name *

Landlord Last Name *

Phone *

SDHC Vendor Number: *

Email

SDHC Excess Wear and Tear

Room	Items		Classification
		Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	Not Applicable
		Requires replacement of the item.	Requires major repairs and effectively precludes the use of the item for its intended purpose	Relatively easily-repairable damage that does not preclude the use of the item for its intended purpose.	No Damage
Kitchen +		(Click on row to expand.)
	Refrigerator	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Dishwasher	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Washing Machine	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Dryer Machine	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Microwave	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Range W/Oven	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Range Hood	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Garbage Disposal	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Kitchen Faucet	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Fire Extinguisher	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Kitchen Cabinet Sink Base	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Kitchen Cabinet Drawer Base	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Kitchen Cabinet Corner Base	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Kitchen Cabinet Trash Can Base	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
Living Room/Bedroom +		(Click on row to expand.)
	Interior Door	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Vertical Blind Package for Door	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Mini Blind Set (Window)	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Exterior Door Knob/Deadbolt Set	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Interior Doorknob Set	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Light Bulb(s)	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Light Fixture	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Outlet Cover Plate	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Smoke Detector/Carbon Monoxide Combo	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Peephole/Doorbell Combo	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Thermostat	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Light Switch Plate	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Window Screen	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Storm Door	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Ceiling Fan	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Sliding Patio Door	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Sliding Closet Door	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Ground Fault Circuit Interrupter (GFI) Receptacle	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Window (Large)	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Window (Medium)	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Window (Small)	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Paint	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
Bathroom +		(Click on row to expand.)
	Shower Stall	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Bath Stall	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Toilet	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Sink	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Vanity	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Medicine Cabinet	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Wall Mirror	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
	Exhaust Fan w/ Light	Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
Other Replacement Items +		(Click on row to expand.)
		Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
		Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
		Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
		Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A
		Heavy/Severe Damage	Moderate Damage	Light Damage/Wear	N/A

Other

Additional Comments

Does tenant owe any unpaid rent? Please select Yes No

Unpaid Rent Amount:

Period of Unpaid Rent:

From:

To:

Check all that Apply

Damaged Vinyl Flooring

SqFt.

Damaged Carpet Flooring

SqYd.

Damaged Drywall

SqFt.

Damaged Drop Ceiling Tile

SqFt.

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