Evergreen Properties: Repair Request Form

First Name*

Last Name*

Street Address*

Phone Number #1 (type as XXX-XXX-XXXX)*

Phone Number #2 (optional)

Email Address*

Fax Number (optional)

Preferred method of contact.*

Call (at the number listed above)Text (at the number listed above)Email (as written above)

Is the alarm armed (if any)?*

YesNo

Has the lock been changed?*

YesNo

Are there any extra locks installed?*

YesNo

Is the fence gate locked?*

YesNo

Do we have access to the inside?*

YesNo

Do we have permission to enter?*

YesNo

Please specify if you would like someone to be present.*

Yes, I would like someone to be present during the repair visit.No, I do not need anyone to be present during the repair visit.

If this is a water heater, heater, or electrical problem - have you checked the breaker?*

Yes, I have check the breakernot a water heater, heater, or electrical problem

Please describe the problem as much as possible.*

Repair cost may be charged to Tenant as applicable per Lease.*

I understand the lease term.

A $60 fee may be charged to the tenant as applicable per Lease Para.20.C.*

I have read this statement and understand.