Repair Request Form

If you would like to hand complete this form, please click here to print.

1128 Gum Branch Road
Jacksonville NC 28540
910-238-2083 Fax 910-238-4213
RENTAL PROPERTY MAINTENANCE/REPAIR REQUEST FORM
All maintenance/repair requests must be in writing and delivered to the landlord’s address stated on the lease agreement.

Date

Email

Property Address

Tenant(s) Name

Tenant(s) Phone* Home Work

*The number provided must be a number that you can be reached for an appointment to be made between 9:00 am – 4:30 pm.
If you know that you will not be home, the contractor will use the key from our office to make the necessary repair.

Please check one of the following and provide the appropriate information:

Do you have a pet? Yes No

How Many? If yes, where is the pet kept? Inside Outside

I give permission to the landlord or its subcontractors to enter my rental home and make the necessary repairs if I am not present.

I accept

Work Requested (Please be specific and provide only one repair per numbered item):

1.

2.

3.

4.

5.

I understand the above and acknowledge that if the repair is found to be of Tenant responsibility or cause, that I will be invoiced for part or all of the incurred charges.

I accept