1. CONTACT INFORMATION

Requesting Party

Resident Name (if different from above)

Email Addresses (and label if needed, i.e. owner - tenant - authorization etc

Repair Address (please include Suite#, Apartment # Etc.. AND Zip Code

example: 1234 Apple St. Apt # A, San Diego, CA 92120

Please list Phone#s

examples: 619-640-9000 owners cell,  858-541-7000 tenant (jim),  760-741-9000 manager (steve)

2. Repair Request

Brand and Type of Appliance
example: Maytag Washing Machine

Description of Problem
example: Will not spin

Model and Serial Number if Available (Required for Warranty work)

When would you like repair appointment (we offer AM & PM appointments Mon-Saturday

example: Tuesday PM  or  Wed AM  or  Call me to arrange