*Name:

Address:

Apartment:

*Phone Number (home):

Phone Number (office):

Email:

Please specify a convenient time we may contact you:
Anytime Weekly A.M. Weekly P.M.
Week-End A.M. Week-End P.M.

REPAIRS TO EXECUTE

Bathroom
Repair the toilet seat.
Relace or solidify the towel rack.
Unplug toilet.
Unplug sink.
Repair sink faucet.
Repair bath faucet.
Other.
Kitchen
Repair sink faucet.
Unplug sink.
Remove the module to install a dish-washer.
Adjust cupboards.
Other.
Miscellaneous
Adjust closet door.
Repair keyhole.
Repair handrail on staircase.
Repair smoke detector.
Other.
Description of repairs to be executed:



*Mandatory fields