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Repairs Request
HOA Community
Unit Number Within the Community
Date of Request
Item Requiring Repair
Urgency of Request
High
Medium
Low
Tenant's Information
First Name:
Last Name:
Address:
Address:
City:
State/Province:
ZIP/Postal Code:
Phone:
Email:
Payment Information:
Processing Fee Rates:
Cards:
3% plus $0.55 ($1.55 min)
(1.5% surcharge for foreign cards)
eCheck:
$0.55
Method of Payment:
Credit/Debit Card
eCheck
Update Name from Above
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
Change Payment Method
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