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Intake Form

Landlord Notification Under ACT 278

To meet Act 278 requirements complete this form in its entirety and attach 10 day notice.

Before You Begin

  • Know the tenant's address and contact information. Tenant's email and/or phone number must be provided to complete the form.
  • Have your eviction notice ready (you will need to upload it).
  • Allow approximately 5-10 minutes to complete the form.

10-Day Notice Templates:

Your Contact information

Name*
Please select the mediation center where the property is located.
If you have an Authorized Agent (i.e. Attorney or Property Manager) who will be participating in the mediation session, please provide their information below.
:

Tenant(s)

Please provide the contact information for the tenant. You must provide their phone number and/or their email.

Lead Tenant's Name*
Tenant Address*
Do you need an interpreter?*

Mediation Process

Mediations will primarily be conducted remotely on Zoom. The equipment needed for a Zoom mediation is: a working computer or tablet with microphone, speakers, and a camera; sufficient internet bandwidth to accommodate video conferencing; and a private place from which to participate. No one else may be in the room or able to overhear the mediation.

If you do not have the appropriate equipment, the selected mediation center may be able to assist you with in-person mediation.

I have the appropriate equipment, as listed above, to participate in Zoom mediation*
How was the Notice provided to the tenant or how will the Notice be provided to the Tenant?*
Or drop files here




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