Perth and Stratford Housing Corporation-Maintenance Request Form 601

Contact Information

Tenant Name

Address/Unit

Phone

Email

Alternate Contact Information (must be provided if you do not have a phone number)

Name

Phone

Email

Please place a check mark beside the type of maintenance needed

Plumbing

Electrical

Flooring

Pest Control

Appliance Repair

General Repair

Locks/Doors

Inspection

Additional comments regarding the maintenance required

Pets

Do you have any pets?

Yes

No

Permission to Enter

I do not require advanced written notice and give staff and/or a contractor representing the Housing Division permission to enter my unit to do the repair and/or check the problem without 24 hour notice.

Yes

No

Would you like to include a photo to help us better understand the issue?

Browse…

Allowed extensions pdf, doc, docx, jpg, jpeg, gif, png, tif

Please Note: Most work orders have 30-day turnaround time. Some repairs that are not a result of normal wear and tear nature may result in a tenant charge.

Date

Signature

Clear

Notice of Collection

Personal information on this form is collected under the authority of the Housing Services Act, 2011 and will be used by The Corporation of the City of Stratford Social Services staff for the purpose of responding to the request, and other administrative purposes. Questions regarding the collection and use of this information should be directed to the City Clerk, 1 Wellington Street, P.O. Box 818, Stratford ON, N6A 6W1; by telephone at 519-271-0250 x 5329 or email during business hours clerks@stratford.ca.

If you require this document in an alternate format, please contact the Clerk’s Office at 519-271-0250 extension 5237 or clerks@stratford.ca