LAKERIDGE MAINTENANCE REQUEST FORM

Note: All Fields Are Required

Contact Information:

Name:

Daytime Phone:

Evening Phone Number:

Cell Number:

Email Address:

Maintenance Request Information:

Apartment Number:

Permission to Enter: Yes No

3 Hour Time Period and Date, if no permission to enter:

2nd Preference of 3 Hour Time Period and Date, if no permission to enter:

Priority: Low Medium High

Type of Problem: Plumbing Electrical Appliances Lights Doors and Windows Window Coverings Flooring Walls Other

Location of Problem: Bedroom 1 Bedroom 2 Living Room Dining Room Kitchen Bathroom 1 Bathroom 2 Other Outside Roof

Problem Description (please describe the problem with as much detail as possible):