LCHA Resident Maintenance Request

Date*
MM slash DD slash YYYY
Name*
First Last
Address*
Street Address Apartment Number City
Telephone Number*
If we cannot contact you directly, LCHA cannot process a maintenance request.
Email*
Nature of the Problem*
Please provide a brief description of the problem.
Location of the Problem*
Please provide the location of the problem in the home.
Detailed Description of the Problem*
Please provide details of the problem.
Any other information that could be helpful with this request:
Submission ID
CAPTCHA