Velika Realty Inc.

Maintenance & Repairs Request

First Name:

Last Name:

Email:

Residing Address & Unit:

Phone Number:

This Request for repair work shall be considered permission to enter your unit. If Velika Realty maintenance staff cannot gain entry to the unit, a service charge of $25.00 may be issued.

Permission to Enter:

Yes	No
If Yes, please give the best date and time to enter:

Do you have a security system?
Yes	No

Do you have a pet?
Yes No If Yes, please specify the type of pet you have:

Please Describe in as much details as possible, your current repair/maintenance issue: