Name
*
First
Last
Email
Phone Number
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Alt Phone Number
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Address
Street Address
Address Line 2 (Suite / Apt #)
City
State / Province / Region
Postal / Zip Code
Product
__________________________
ARTIC AIR
AMANA
ASKO
AVANTI
BEVERAGE AIR
BADGER
BERTAZZONI
BLUESTAR
BROWN
BOSCH
BRADFORD WHITE
CALORIC
CARRIER
CHROMALOX
CLIMATROL
CROSLEY
DACOR
DAEWOO
DCS / FISHER PAYKEL
DEFLECT-O
DANBY
DYNASTY
ELECTROLUX
EQUATOR
EXACT REPLACEMENT PARTS
EWAVE
FISHER PAYKEL
FRIGIDAIRE
FIVE STAR
GALAXY
GARLAND
GENERAL ELECTRIC
GIBSON
GOLDSTAR
GREENWALD
HAIER
HEARTLAND
HELMER
HOTPOINT
IDW-USA
IN SINK ERATOR
JADE
JC PENNEY
JENN-AIR
KITCHEN AID
KELVINATOR
KENMORE
L-G
LACANCHE
LIEBHERR
LITTON
MAGIC CHEF
MAYTAG
MODERN MADE
MONOGRAM
MONTGOMERY WARD
PANASONIC
PEERLESS
PERFECT AIRE
PREMIER
QUASAR
ROBERT SHAW
RCA
REGENCY
REVCO
ROPER
RUUD
SAMSUNG
SANYO
SUNBEAM
SEIMANS
SHARP
SPECTRA
SPEED QUEEN
SUMMIT
SUNRAY
SUPCO
SUB ZERO
TAPPAN
THERMADOR
TOSHIBA
TRUE
ULINE
UNASSIGNED
UNIVERSAL
VENMAR
VENTLINE
VERONA
VIKING
FRIDGIDAIRE
WHYNTER
WOLF
WOODS
WHIRLPOOL
WHITE WESTINGHOUSE
Brand
*
Air Condetioner CENTRAL
Air Conditioner WINDOW
Cartridge
Cooktop Electric
Cooktop Gas
Dehumdifiers
Disposer
Dryer Coin Op
Dryer Electric
Dryer Gas
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Dish Washer Built In
Dish Washer Portable
FREEZER CHEST
Freezer Commercial
FREEZER UPRIGHT
Hot Water Tank
ICE MACHINE
LAUNDRY CENTER DRYER
LAUDNRY CENTER WASHER
MICROWAVE BUILT IN
Microwave Commercial
Microwave Counter Top
MICROWAVE OVER RANGE
MICRO WAVE / OVEN COMBO WALL
Pkg Thermal Air Conditioner
RANGE DUAL FUEL
Range Electric
Range Gas
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Refrigerator Bottom Mount
REFRIGERATOR BUILT IN
Refrigerator Commercial
Refrigerator French Door
REFRIGERATOR MINI
Refrigerator Side by Side
Refrigerator Top Mount
Trash Compactor
VENT HHOD
Washer Coin Op
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Washer Front Load
Water Heater
WINE COOLER
Wall Oven Double
WALL OVEN MICROWAVE COMBO
Wall Oven Single
Washer Top Load
Product
Model
Serial
Thank you for providing your complete model and serial number from the appliance tag. It gives us a lot of information and can help us complete your repair faster.
Purchase Date
An accurate purchase date is required for warranty service. If your product is out of warranty then only the year of purchase is required. Thank you.
MM
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DD
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YYYY
 
If this is warranty please provide the Dealer that you purchased the appliance from
ABC WAREHOUSE
AMAZON
ANDERSON'S
APPLIANCE CENTER
BEST BUY
BIG GEORGE
COSTCO
DUROCHER'S
FRANK'S SALES
GOEDEKER'S, BALLWIN, MO
HOME DEPOT
IKEA
LOWES
HOME CENTER
MARTINS HOME CENTER
MENARDS
SEARS
WILMAR
WHIRLPOOL
Dealer
If Dealer is not in the list
City
 
Problem
Request Date/Time
(This is only a request. Someone will contact you shortly to schedule an appointment.)
AM
PM