Tenants Account Number Owners Account Number 2812 North Main Street Anderson, South Carolina 29621 Office: (864) 224-2536 Fax: (864) 224-9547 www.andersonpm.com Work Maintenance Request Form After hours phone # 864-965-8151 All tenants must submit work request in writing to be compliant with lease agreement. I acknowledge that by law APM or service provider is allowed to enter my premise any time between the hours of 8 AM & 8 PM to complete this work I requested without any further notice to the tenant. E-mail us: apm@andersonpm.com Tenants Name: ___________________________Signature___________________________ Date of Request: ____________________________ Property Address: ____________________________________________________________ Phone Numbers: Daytime (_____)- _______- __________, Cell (_____)-______ __________ Best Time to contact you: ________AM to ________PM. Type of problem: (Circle one): Structural Flooring covering Electrical Roofing Plumbing Appliances Gutters landscape issue Heating & Air Utility Services. Please briefly describe he problem you’re experiencing: Emergency: Is defined as something if not dealt with immediately will cause catastrophic destruction or is life threatening. Examples: Fire, electrical failure, heating failure, broken plumbing, flooding, serious structural failures. Priority Level: 1. Emergency = Immediate attention to service # _______ 2. High = Same day service during business hours 3. Medium = Service as soon as possible within 3 days 4. Low = Reasonable attention to service with in 10 days. OFFICIAL USE Date received: _________________________________________________________________________ Name of office personnel receiving: _______________________________________________________ Is problem tenant or owners responsibility: _________________________________________________ Service provider: _______________________________________________________________________ Is problem justified? Y / N. Estimated Cost of repairs: $ ______________________________________ Date & Time Owner was notified: _________________________ & ______________________________ PMIC Signature: ________________________, Date __________Is the Bill & Work Order attached? Y / N .