MAINTENANCE REQUEST
Republic Housing Authority
IF AN EMERGENCY CALL
417.379.3717
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
example@example.com
Phone Number
*
Format: (000) 000-0000.
Choose which one applies to your maintenance request.
*
Please Select
Pluming
Electrical
General Repairs
Appliances
Air Conditioning
Ventilation
Heating
Please enter details of requested work and/or description of problem. INCLUDE the room were the issue is in your apartment.
*
Is this issue causing damage to the property?
*
Yes
No
I would like to be present for repairs.
*
Yes
No
My preferred days and times for repairs are.
*
Hour Minutes
AM
PM
AM/PM Option
I give the Landlord permission to access the property with any necessary tradesperson in order to complete the needed repairs.
*
Yes
No
Picture (if any)
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