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Form #17 : MAINTENANCE REQUEST

Required entries are indicated by blue icons or *

Tenant(s)* (required)

Tenant(s)

et al (and all others)

Property Address* (required)

Unit #

City (Oregon ONLY)

OREGON Zip Code

Tenant Email

Tenant Phone

Describe exact nature of problem(s)

This constitutes authorization for Owner/Agent to enter the rental unit for the requested repairs. This authorization expires in seven (7) days unless repairs are in progress.

Please Note: Signature fields must be filled in and signed by all parties after printing.



Tenant	Date	Tenant	Date

Tenant	Date	Tenant	Date

Tenant	Date	Tenant	Date

Owner/Agent acknowledges receipt of maintenance request.



Owner/Agent	Date	Owner/Agent	Date

Form #17 : MAINTENANCE REQUEST

Rev.4/16

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