General Information

Your Name

Your Email (required)

Your Phone Number (required)

Contact Information

Repair Address

Apt/Unit #

City

Zip Code

 

Billing Customers Info

This section is for Billing Customers only, if you are not a billing customer skip this section and go to the next section

Credit Card VisaMaster CardAmerican ExpressDiscover

Credit Card Number

Expiration Date

Name on Card

Billing Zip Code

Brand and Type of Appliance

Brand of appliance:
Not Listed or Don't Know (that's ok)AdmiralAmanaBoschCaloricChambersColdspotDacorEstateFisher PaykelFrigidaireGaffers SattlerGaggenauGeneral ElectricGibsonHotpointInsinkeratorJenn-AirKelvinatorKenmoreKirklandKitchenAidLittonMagic ChefMaytagModern MaidNorgeO'Keefe & MerritPenney'sQuasarRoperSamsungSanyoScottsmanSears BrandSharpSignatureSpeed QueenSubzeroTappanThermadorToshibaUlineWardsWaste KingWedgwoodWestinghouseWhirlpoolWolf

Type of Appliance:
Please ChooseDishwasherDryerFreezerMicrowaveOvenRangeStoveRefrigeratorWasher

Description of Problem

 

Requested Appointment

Date:


Time:
Please select a timeCall Me To ArrangeMorning7-9AM8-10AM9-11AM10-12AM11-1AM12-2AM12-2PM1-3PM2-4PM3-5PM4-6PM5-7PM

Instructions or Directions

How will payment be made?
I will be there during appointman timeCall Me 20 minutes before arrivalCall me for approval and bill me.Call me for approval my credit card.