Maintenance & Repair Request If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required First Name * Last Name * Email * Phone * Address of Unit: City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Special Entry Concerns? NonePets PresentChildren PresentOther If you selected "Other" Please Describe: Type of Maintenance or Repair Needed: ApplianceDoors/WindowsElectricFloors/CarpetingHeatingPlumbingWalls/CeilingsOther If you selected "Other" Please Describe: Exact nature of problem and cause (if known.) BE SPECIFIC! * Notice: By submitting this form, resident agrees that this electronic request authorizes the landlord or the landlord’s agents to enter the premises without notice at reasonable times to perform the repairs or maintenance. This authorization expires after 7 days unless the repairs or maintenance are in progress and the landlord is making reasonable effort to complete the repairs/maintenance, in which event tenant authorizes entry at reasonable times in excess of seven days until such repairs or maintenance are completed. By submitting this request, Resident also agrees that the Landlord’s maintenance person 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 the Resident under this Maintenance Request, a new notice of entry will be given for the new repair work.