Maintenance Request Form
Location/Links of Interest
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What Apartment are you Interested In (Address and unit #):
Cell Phone Number:
Work Phone Number:
Your Email Address:
Compete Current Address:
When do you want to move?
Are You Gainfully Employed?
If yes, where are you employed and how long have you worked here?
What is the total Number of People who will reside in your unit?
Names of others to live with you:
Are they gainfully employed and where:
How did you hear about us? (Craigslist/LEB Website/Burlington Free Press/Other)
Are you a Smoker?
Do you have a Pet?
If yes, what and how many?
*Please state why you feel you would make an ideal candidate for this apartment: