Maintenance & Repair Request

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Minors *

Yes

No

Animals *

Yes

No

Authorization to enter premises *

Resident agrees that this maintenance request authorizes Owner/Agent to enter the premises with notice at reasonable times to perform the repairs/maintenance. This authorization expires after seven (7) days unless the repairs/maintenance are in progress and Owner/Agent is making reasonable efforts to complete the repairs/maintenance, in which event Resident authorizes entry at reasonable times in excess of seven (7) days until such repairs/maintenance are completed. By checking the box, resident also agrees that Owner/Agent's staff may conduct a preventative maintenance inspection while in the unit and, to the extent practical, do any necessary repairs. If it is not practical to perform the repairs in conjunction with the repairs requested by Resident under this Maintenance & Repair Request, a new notice of entry will be given for the new repair work.

Yes

No