Maintenance Work Order

Elkhart Housing Authority Logo

Elkhart Housing Authority
Phone: 574.295.8392 • Fax: 574.293.6878
1396 Benham Ave. • Elkhart, IN 46516
Monday-Friday 8 am-4:30 pm
Closed for Lunch 12 pm-1 pm
Equal Housing, Handicap Accessible, and Accessibility Icons.

Fields marked with * must be completed or form will not submit.

[{"type":"text","required":true,"label":"First Name","name":"first-name","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Last Name","name":"last-name","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Street Address","name":"street-address","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"City","name":"city","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"State","name":"state","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Zip Code","name":"Zip-code","className":"col-lg-4","subtype":"text"},{"type":"text","subtype":"email","required":true,"label":"Email","name":"email","className":"col-md-6"},{"type":"text","subtype":"email","required":true,"label":"Email Confirmation","name":"email-confirmed","className":"col-md-6"},{"type":"textarea","required":true,"label":"Type of Repair","name":"type-of-rep","subtype":"textarea","className":"d-block"},{"type":"text","required":true,"label":"Message","name":"message","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Preferred Time of Maintenance Visit (cannot be guaranteed)","name":"preferred-time-of-maintenance-visit-cannot-be-guaranteed","className":"d-block","subtype":"text"},{"type":"file","label":"Upload an Image","description":"Please select one or more files for upload. You may upload up to 20 files (35 Mb max). Files can be PDF, JPG, JPEG format. To upload multiple files, please hold control while clicking on multiple files before clicking \"Open\".","name":"upload-an-image","subtype":"file","multiple":true,"className":"col-md-6"},{"type":"radio-group","required":true,"label":"Pet in Apartment?","inline":true,"name":"pet-in-apartment","className":"col-md-6","values":[{"label":"Yes","value":"Yes"},{"label":"No","value":"No"}]}]