Ned Baker Real Estate - Maintenance Request Form

2339 State St • Salem, OR 97301 • 503.364.6797 • 800.000.0000 • 503.364.6798 fax

Date:
Tenant Name:
Complex Name:
Dwelling Address:
City:
State:
Zip Code:
Phone Number:
Email Address:
Type of Maintenance or Repair: Exact nature of problem and causes, if known. PLEASE BE SPECIFIC.
Signature: Typing your name here and submitting this form via email constitutes authorization to enter the unit for the requested repair.