MAINTENANCE REQUEST FORM
Section 1: Completed by Requestor
Full Name
*
First Name
Last Name
Location in School of the Request (ie. room #, office, etc)
*
E-mail
*
example@example.com
Phone Number
Please enter details of requested work and/or description of problem. Include specific details and instructions as necessary.
*
Priority Level
Please Select
High (as soon as possible)
Medium (within 2 weeks)
Low (as time permits)
Picture (if necessary)
Upload a File
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Choose a file
Cancel
of
Click submit and your request will be sent for department approvals. An email notification will be sent informing you of the status of your request. If you have any questions, please contact Amanda at 414-873-4014 ext. 227.
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Section 2: Completed by Maintenance Department
Name
First Name
Last Name
Estimated Time Needed to Complete Request (include minutes or hours)
Estimated cost for materials needed. Please list out more details if necessary in comment space below.
Product Name
Unit Price ($)
Quantity
Total Cost ($)
1
2
3
4
5
Estimated Labor:
Unit Price ($)
Number of Hours
Total Cost ($)
Labor
Comments/Concerns:
File Upload (if necessary)
Browse Files
Drag and drop files here
Choose a file
Cancel
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Date Projected to be Completed By
-
Month
-
Day
Year
Date
Submit
Should be Empty: