2. Hampton County
   Maintenance Request Form
4. Use this form to request maintenance.
6. 
   Maintenance must be at a county-owned facility. The exact reported location/building address is required.
   
   
8. Please use one form per request!
10. Date:*
12. Time:*
14. 
    Contact Information
16. Department Making Request:*
    -- Select One --Administrator's OfficeAnimal ShelterAssessorAuditorBoard of Elections and Voter RegistrationBuilding & GroundsBuilding Dept. & PermitsCentral Dispatch (E911)Clerk of CourtCode Enforcement (Landfill)Code Enforcement (Veh. Reg.)CoronerCouncil on AgingCounty Council/Clerk to CouncilDelinquent TaxDetention CenterEconomic DevelopmentEmergency PreparednessEmergency ServicesFinanceFire DepartmentGrants AdministrationHuman ResourcesInformation TechnologyLandfill/Solid WasteMagistrate CourtMaintenance ShopProbate CourtRecreation DepartmentRecycling/Solid WasteRisk ManagementRoads & BridgesSheriff's DepartmentTreasurerVeteran's Affairs
18. Work requested by:*
20. Phone Number:*
22. Email Address:*
24. 
    Exact Location of Requested Maintenance:
26. Please describe the work being requested:*
28. Address of building:*
30. 
    Maintenance Department Use Only.
32. Work Order No.:
34. Purchase Order #:
36. Date Order Received:
38. Time Order Received:
40. Parts/Materials Used:
42. Date Completed:
44. Time Completed:
46. Remarks:
48. Work Completed by:
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit Submit and Print

* indicates a required field