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* Property Name:    
* Tenant Name: Lease Number:  
* Tenant Email Address: Tenant Phone:
** Please enter both as displayed on your monthly invoice
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Type of Repair:
Landscaping & Grounds Pest Control
Parking Lot Lighting Waste Removal
Roof Other
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Regency Headquarters

One Independent Drive
Suite 114
Jacksonville, FL 32202-5019
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Phone: 904.598.7000
Toll-Free: 800.950.6333
Fax: 904.634.3428