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Service/Repair Request Form
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First and Last Name:
Email:
Phone Number:
Address:
City, State, Zip Code:
Best time to call:
Morning
Afternoon
Appliance Type:
Please Select:
Refrigerator
Stove Gas
Stove Electric
Dishwasher
Clothes Washer
Clothes Dryer
Freezer
Microwave Oven
Garbage Disposal
Trash Compactor
Ice Maker
Other Appliance
Appliance Manufacturer:
Please Select:
Admiral
Amana
Bosch
Electrolux
Fisher and Paykel
Frigidaire
GE
GE Monogram
Hotpoint
Jenn-Air
Kenmore
KitchenAid
LG
Maytag
Roper
Samsung
Sub-Zero
Tappan
Thermador
Viking
Wards
Westinghouse
Whirlpool
Wolf
Other Manufacturer
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Problem Description or Additional Information: