Maintenance Request Form

In accordance with the Kansas Residential Landlord and Tenant Act, KSA 58-2553

Date of Application*

Email Address:

Enter Email Confirm Email

To: (Landlords)*

Landlord Name	Street Address	City/St/Zip

From: (Tenants)*

Tenant Name	Street Address	City/St/Zip

Address of Rental Unit*

Street Address

List of Repairs*

Written maintenance requests provide a good record for the tenant and a good reminder and record for the landlord. Kansas Law (KSA 58-2557) provide that a landlord must have the tenant's consent to enter the tenant's home, and entry must be at a reasonable time after reasonable notice has been given. The optional sentence allows tenant(s) to provide contact information it tenant(s) wish to be home when the maintenance is done.

Do you want to be home during the repairs?*

Yes
No

When can repairs be made?*

Day	Time

Who to contact and when to make arrangements?*

Contact Name	Contact Number	Time

Consent*

I give consent to the maintenance statement.

The above mentioned maintenance and or repairs listed above are needed at the Address of the Rental Unit listed above that I/we rent from you. I give consent that you contact me at the numbers above at the times above to make arrangements .

Housing Maintenance Request Form