Maintenance/Service Request

Current Date:	(mm/dd/yy)
Which office can best serve you?:
Best Way To Contact Me
Your Name
Property Address:	Unit #:
City:
Home Phone:	Work Phone: Cell Phone:
Working Email:
Have You Reported This Issue Before?	Yes	No	Are There Pets In The Home:	Yes	No
Describe The Problem: (Be as specific as possible including room/location and any details to help us diagnose the problem. Include make/model/serial number for appliances)

In The Box Below What, If Any, Action Have You Taken To Fix The Issue, or To Determine The Cause

You Will Be Charged For The Repair/Service Call (Including Trip Charges):

If damage or repair need was caused by any of the authorized residents or their guest/invities (clogged garbage disposal/sink/toilet, misused appliance, not changing A/C filters, smoke detector batteries, flipped breakers. sliding screen/door off track, etc.)

If you miss an appointment with a service technician or assigned vendor - $50.00 charge applies.

By Submitting This Form You Agree and Acknowledge The Terms and The Terms Of Your Lease

I have read, understand, and agree to the following
(Submission will not be accepted unless checked)

After You Press The Button Below You Will Forwarded To A Printable Page.

Maintenance/Service Request
Daytona: Phone: (386) 760-6000 Fax: (386) 760-1141	Melbourne: Phone: (321) 724-9500 Fax: (321) 728-8422	Ocala: Phone: (352) 624-9300 Fax: (352) 624-2470
Port Charlotte: Phone: (941) 629-1121 Fax: (941) 625-5959	Port St. Lucie: Phone: (772) 335-1995 Fax: (772) 335-3467	Vero Beach: Phone: (772) 567-5226 Fax: (772) 569-3985
Use this online form to submit a general maintenance and service request. For life threatening emergencies call 911. For emergency service call the number above that is local to your area and follow the prompts for emergency service. Burst/leaking pipes, water intrusion, preservation of the unit and prevention of further damage are some examples of emergency service. Air conditioning and appliances repairs ARE NOT emergency repairs; however, they are treated as priorities. (If you wish to FAX or mail this document fill out the form and press Submit. The next page is suitable for printing a completed form. Don't forget to sign it.)