HOUSING DISREPAIR FORM
0203 781 7780

Title (*)
Forename (*)

Surname (*)

Email (*)

Contact Number (*)

Property Type (*)
House Flat

Private or Council/Housing Association (*)

Property owner's name (*)

Date moved in the property (*)

Rent Arrears (*)

Any Repairs Carried out (*)
Yes No

Is issue still ongoing(*)
Yes No

Description of the issue (*)

Best time to call back(*)

Where did you hear about us (*)

* Mandatory fields