Home Repair Request
Please complete this application for home repair. Note that we receive your request the same day you complete the application online and will contact you as soon as possible.
Do you own your home?
If so, how long have you owned it?
# of Family Members who live in the home?
Age of each member would be helpful. ex: (2) 65, 70
Home was flooded?
Current living situation?
Description of Work Requested
Please be as specific and descriptive as you can, as this will allow us to process your application much more quickly
Other Pertinent information
Children in Home
If you are a case manager- name/ph
Case Managers: We need your name and contact number when we call the applicant. Please remember we are a small organization, dependent on volunteer labor and are slow to respond.
I understand that RTBR may offer assistance to complete interior gutting, mold control or remediation, and partial rebuilding services. They do not guarantee that any sanitizing treatment is able to fully prevent mold from growing.
This assistance is only available to homes owned and occupied by the homeowner. Documentation must be provided for proof of ownership. Additionally, RTBR will not complete work on any homes covered by Flood Insurance.
Items removed from the home will be left at the front of the property to be disposed of. RTBR will not be removing items from the property.
Homeowner presence is required while RTBR and volunteers are on site. _________________________________________________
ALL FIREARMS AND/OR OTHER WEAPONS MUST BE REMOVED FROM THE HOME BEFORE THE SCHEDULED WORKDAY, legal or not. If any of these items are found while work is being done on your home, work will cease immediately.
RTBR will be using volunteers to complete the work on the home.
RTBR can not guarantee the timeline for completion of work on your home or the ability to complete work for all individuals in need since we are reliant on donations from the community as well as availability of supplies and volunteers. Work will be scheduled in the most efficient manner possible.
I have answered all the questions on form truthfully. The original or a copy of this form will be retained by RTBR.
Homeowner Electronic Signature (type your name to accept)
Send me a copy of my responses
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