Maintenance Request

* Required Field

Tenant Information
First Name	Last Name
Phone Number	Email
Address	Unit Number (if applicable)

Work Requested
The undersigned Tenant requests and authorizes Landlord and Landlord's agents to enter Tenant's rental unit to perform maintenance as described below:

Upload Images
Add up to six photos related to the maintenance work requested

Time Period for Authorized Entry for Maintenance Days Available:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Additional time restrictions:
Note: If no time period is specified, Landlord and Landlord's agents are authorized to enter 8 a.m. - 5 p.m. Monday through Friday. Caution: Stating limited time periods for authorized entry may delay repairs.

NOTICE OF DETERIORATED PAINT (POTENTIAL LEAD-BEARING PAINT HAZARD)

Deteriorated lead-based paint may create a potential lead-bearing paint health hazard, especially for children under the age of six. It is the tenant's duty to report deteriorating paint conditions (cracking, peeling paint, worn paint on friction/impact surfaces and other potential lead-bearing paint hazards - see lines 65-69) that cause exposure to lead. The undersigned Tenant (please include phone numbers) hereby notifies Landlord or Landlord's agent that the following deteriorating paint conditions (or other potential lead-bearing paint hazards as described in the Lead-Based Paint: Protect Your Family Pamphlet) may be present in Tenant's rental unit or in common areas accessible to Tenant (specify type and location of deteriorating paint or other potential lead-bearing paint hazards:

View related notice statutes and rules

Theisen Re/Max Real Estate Group

715-835-6191 •
1808 Brackett Avenue • Eau Claire, WI 54701

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Maintenance Request

Tenant Information

Work Requested

Upload Images

Time Period for Authorized Entry for Maintenance

Days Available:

Additional time restrictions:

NOTICE OF DETERIORATED PAINT (POTENTIAL LEAD-BEARING PAINT HAZARD)

Theisen Re/Max Real Estate Group

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