Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred Date 1 *

No Weekends/Holidays

MM

DD

YYYY

Preferred Date 2 *

No Weekends/Holidays

MM

DD

YYYY

Preferred Date 3 *

No Weekends/Holidays

MM

DD

YYYY

Consent to Share Tenant Contact with Maintenace *

Yes, I agree to share my contact info to maintenance (i.e. to receive a 30-minitue time frame call)

No, I do not agree to share my contact info

Consent to Pay Non-covered Items *

Such as Water heater, AC are covered by Landlord; Light bulbs are tenants responsible; Dishwasher and Fridge are provided for your convenience, tennants need to pay parts when fixed along with landlord responsible items during one trip or pay full (parts+labor) when fixed alone.

Yes, I agree to pay non-covered items.

No, I do not agree pay non-covered items. I do not need maintenance at this point.

May I know if this request covered by landlord for both parts and labor or labor only or it is my responsibility.