Maintenance Request Form

MAINTENANCE REQUEST FORM
Date Submitted: [Date] | Time: [Time]
TENANT INFORMATION:
Tenant Name: ________________________________________
Property Address: _______________________________________________________________
Unit/Suite Number: _____________ | Phone: ______________________
Email: _________________________________ | Best Time to Call: ____________
Property Manager/Landlord: _______________________________________________________
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DESCRIPTION OF PROBLEM
Location in Unit (specific room/area): ____________________________________________
PRINCIPAL ISSUE (check all that apply):
☐ Plumbing (leak, clogged drain, no water)
☐ Electrical (outlet/switch not working, no power)
☐ HVAC/Heating (no heat, AC not cooling, thermostat issue)
☐ Appliance (refrigerator, stove, dishwasher, washer, dryer)
☐ Pest/Rodent (insects, rodents, infestations)
☐ Structural (cracks, damage to walls/ceiling/floor)

[Section 2 — continued...]

[Section 3 — fill in your details...]

[Additional clauses and provisions apply...]