Name *

First Name

Last Name

Phone

(###)

###

####

Are you behind on rent?

Yes

No

How urgent is your maintenance request? *

EMERGENCY -Flood or Fire ONLY

Priority - Serious issue, but NOT an emergency. No heat, no water, no power anywhere, locked out, no hot water, active leak (not a flood), etc.

Routine Maintenance - Can be scheduled. General maintenance, minor repairs, slow drains, appliance issues, etc.

Category *

Please select ONE of the following that best fits your maintenance request.

A/C, Heat, Ventilation

Appliances

Doors or Windows

Electrical

Exterior

Flood

Lock Out

Pest Control

Plumbing

Structural

Water Heater

Water Leak

I understand that by submitting this Maintenance Request form I am granting Valiant Property Management permission to enter the unit to complete the Maintenance Request. *

I understand and agree to the terms

I understand that Valiant Property Management staff will not enter a unit if an aggressive animal is not kenneled or an unattended minor is left in the unit. *

I understand and agree to the terms

I acknowledge that maintenance requests are completed in the order they are received, and I understand that a specific date and time for service cannot be guaranteed. *

I understand and agree to the terms

I understand that if I am found to be at fault for the maintenance issue I will be responsible for all costs associated for the repair per my lease agreement. *

Example but not limited to: Your toilet is clogged because you are flushing baby wipes or feminine products.

I understand and agree to the terms

Date *

MM

DD

YYYY

Time *

Hour

Minute

Second

AM PM