Intake Form For HQS Inspection
Who Are You In Relation To This Unit ?
*
Please Select
Tenant
Property Manager
Owner/Operator
Other
If Not The Tenant Enter Your Name and Company Name Here:
If you are the tenant you may skip this step and move on to the next.
Best Phone Number To Reach You At?
*
Format: (000) 000-0000.
Please Check All That Apply:
Yes, you may call me at this number!
Yes, you may text me at this number!
I have an alternative number, extension or contact information I will include in the "Additional Information" space at the bottom of this form.
Housing Authority This Inspection is For:
*
Please Select
Dover Housing Authority
Rochester Housing Authority
Somersworth Housing Authority
Newmarket Housing Authority
Tenant Name
*
First Name
Last Name
Address To Be Inspected
*
Street Address
Unit Number
City
State / Province
Postal / Zip Code
Additional Information
Thank you for completing the intake form, we will be in contact to schedule your inspection!
Submit
Should be Empty: