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Broken Lease/Eviction Support Intake
Basic Information

Full Legal Name

What is your phone number

What is your email address

Have you already had a consultation with us?

Yes

🪪 1. Government-Issued ID

🧾 2. Social Security Card

🏠 3. Proof of Address

Housing & Lease Details

Current Address (required)

Property Address of Broken Lease/Eviction (required)

Landlord / Property Management Company Name (if known)

Approximate Move-in Date

Date of Lease Break / Eviction Filing

Eviction / Lease Status

Was this a:

Broken Lease

Eviction (Filed in Court)

Both

Do you have court documents or notices related to this case?

Yes (I can upload or provide)

Has this been reported to the credit bureaus?

Yes

Unsure

Credit Bureau(s) Reporting the Issue (multi-select

Experian

Equifax

TransUnion

Not Sure

Financial Details

Outstanding Balance Claimed (if any):

Have you made any payments toward this balance?

Yes

Next Steps

What is your housing goal right now?

Secure new apartment approval

Resolve balance with landlord

Remove eviction record from reports

Other: _____________________

Consent & Agreement

I acknowledge that FS Realty provides housing support services, including consultation, document preparation, and assistance with broken lease/eviction challenges. I authorize FS Realty and FFS to review my case details and provide next-step recommendations.

Untitled checkboxes field

I Agree