Maintenance Service Request

Fill out and submit this form to notify us of maintenance that needs to be done on our campus. If you prefer, you may instead fill out a paper form in the church office.

Information with a red "*" is required. Please make sure you include some fom of contact info - either phone or email - since we often need additional details to make sure we complete the maintenance properly.

Name: *

Daytime phone:

Phone number to contact you if we need additional information.

Evening phone:

Email:

Used to send a confirmation of your maintenance request, and in case we need additional information about this request.

Location or room number: *

The room or location on campus where the problem is.

Location:

Location of the problem, if not specified above.

Nature of issue or request: *

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Math Question: * 9 + 5 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

Lutheran Church of the Resurrection

For Members

Maintenance Service Request