Free maintenance request form 10
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Description of Work

Submitted by
Email
Phone
Department
Building/Room
Account number
Date Submitted
Completion By

Received by

Hours Worked Record
Date

Time

Initials

Materials Used Record
Quantity

Item

Amount

Total $
Materials Ordered Record
Date

Item/Vendor

Amount

Total $

Stock & Ordered Materials Total $
Total hours _______________ x $_______ per hour + Other Misc. Charges of $______________ =
Total charges for the sheet $