Maintenance Request
Tenants Request Form
Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: 00000000.
Email
*
example@example.com
House Number
*
Issue Type
Plumbing or water leakage
Electrical problem
Roof leakage
Door or window damage
Floor or wall damage
Toilet or bathroom problem
Septic or drainage problem
Other
Location
*
Please Select
Betio
Bairiki
Nanikaai
Bikenibeu
Tanaea
What is the best time
Issue Description
*
Upload image
*
Browse Files
Drag and drop files here
Choose a file
you can upload only 20mb
Cancel
of
Submit
Should be Empty: