YOUR INFOMATION:
First Name:
*
Last Name:
*
Email:
Phone #:
Alt. Phone #:
Street:
Suite/Apt #:
City:
State:
Zip Code:
YOUR PRODUCT:
Brand:
ADMIRAL
AMERICAN RANGE
No Brand
AGA
AIRKING
ALFRESCO
AMANA
ARC
ARTISAN
ASKO
AVANTI
AMERICAN WATER HEATER
BEDGEAR
Bedtech
BERTAZZONI
BEST
BLAZE
BOSCH
BROAN
Chattam & Wells
CARRIER
COZZIA
CROSSOVER
CROSLEY
DACOR
DAEWOO
DANBY
DREAMCLOUD
DCS
delete
DEY DISTRIBUTING
ELECTROLUX
FABER
FAGOR
FHIABA
FISHER
FRIGIDAIRE
FULGOR MILANO
GAGGENAU
GENERAL ELECTRIC
GLADIATOR
GLIDEAWAY
HAIER
HEALTHY SLEEP
HOLLYWOOD
HOTPOINT
INSINKERATOR
JENN AIR
KENMORE
KINETIC
KITCHENAID
Knickerbocker
KOLDFRONT
LIEBHERR
Leggett
LG
LYNX
MALOUF
MARVEL
MAYTAG
MIDEA
MISCELLANEOUS
Mattress King Collection
MIELE
MONOGRAM
NDA DISTRIBUTING
NORTHLAND
NOT DEFINED
PREMIER
RAGALTA
Reverie
RENTAL UNIT
Restonic
Stearns & Foster
SAMSUNG
SCOTSMAN
Sealy
Serta
SETOMATIC SYSTEMS
SEALED UNITS
SHARP
SILHOUETTE
SMEG
SOC
SOLEUS
SPEED QUEEN
SUB ZERO
SUMMIT
Tempurpedic
THERMADOR
Therapedic
THOR
TRADE WIND
U LINE
UNASSIGNED
VECTORNATE
VENT A HOOD
VERONA
VIKING
WASTE KING
WHIRLPOOL
WINIA
WASTEMAID
WOLF
WHIRLPOOL
ZEPHYR
Product:
DISHWASHER ESP
ELEC. COOKTOP ESP
ELEC. DRYER ESP
BUILT-IN ELEC. OVEN ESP
ELEC. RANGE ESP
GAS COOKTOP ESP
GAS DRYER ESP
BUILT-IN GAS OVEN ESP
GAS RANGE ESP
VALET/DRY CAB ESP
BUILT-IN MICRO ESP
OTR MICRO ESP
BUILT-IN MICRO/OVEN COMBO ESP
REFRIGERATOR ESP
PRO STYLE OVEN ESP
PRO STYLE RANGE ESP
WASHER ESP
MISC/OTHER ESP
3 YEAR SERVICE CONTRACT
5 YEAR SERVICE CONTRACT
AIR CONDITIONER BUILT-IN
ACCESSORIES
DUCTLESS
HVAC
AIR CONDITIONING PART
PORTABLE
PTAC
AIR CONDITIONER WINDOW MOUNTED
Adjustable Bases
ADVANTIUM MICROWAVE NIB
APPLIANCE ENTRY
APPLIANCE FACTORY OUTLET PROPE
AIR CONDITIONERS/HEATERS/HUMID
AIR CONDITIONER
ALL-IN-ONE
HEATER
BED Accessories
Bunkie Boards
BSIC BOTTOM FREEZER
BBQ EQUIP & ACC.
BUILT-IN
FREESTANDING
BASIC DRYER ELECTRIC
BASIC DRYER GAS
BASIC DISHWASHER
BASIC FRENCH DOOR
BUILT IN COUNTERTOP MWO
BUILT IN MVO
BUILT IN SPECIALTY
BASIC OVER THE RANGE MWO
Box Springs
MATTRESS PART
OLD BASIC RANGE ELECTRIC
OLD BASIC RANGE GAS
OLD BASIC SIDE BY SIDE
OLD BASIC TOP FREEZER
OLDBASIC COMPACT REFRIGERATION
BUILT-IN
FREESTANDING
BASIC WASHER
ACCESSORY
CHEST FREEZER
COOKTOP
BUILT IN
COFFEE MAKER
COOKTOP ELECTRIC NIB
COIL
ELECTRIC SMOOTHTOP
GAS
INDUCTION
COUNTERTOP MICROWAVE
UNIT NOT RETURNABLE/NOT REFUND
DISPLAY DISCOUNT ALLOWANCE
DOWNDRAFT VENT
DELIVERY CHARGE
Discontinued Foundation
DEHUMIDIFIERS
DISPLAY
Discontinued Mattresses
DISHWASHER PART
COMMERCIAL F/L ELECTRIC DRYER
COMMERCIAL F/L GAS DRYER
DRYER ELECTRIC
DRYER FL ELEC
DRYER FL GAS
DRYER GAS
DRYER PART
DRYER PORTABLE
DRYER TL ELEC
DRYER TL GAS
DISPOSER
DISHWASHER
DISHWASHER BUILT-IN
DW BUILT-IN
DW COUNTERTOP
DW DRAWER
OLD DW PORTABLE
DW PORTABLE
ENERGYSTAR DRYER ELECTRIC
ENERGYSTAR TOP LOAD
ELECTRICAL
ENERGYSTAR TOP LOAD
ENERGYSTAR WASHER
Firm Mattress
UNIT NON RETURNABLE/NON REFUND
Freezers All Freezer NIB
FAN
Freezer Chest NIB
Freezer Frost Free Upright NIB
WASHER - FRONT LOAD
Freezer Manual Upright NIB
FRIDGE PART
ALL FREEZER
FREEZER CHEST
COLUMN
COMPACT
DRAWER
FRAMES
UNDER COUNTER
UPRIGHT
FREEZER
BATCH FEED
CONTINOUS FEED
Garbage Disposals NIB
GRILL
GRILL
Hybrid Mattress
ACCESSORY
VENT HOOD NIB
HOOD PART
HEATER
ICE MAKER
ICE Machine
BUILT-IN
FREE STANDING
ACCESSORY
ACCESSORY
COMMERCIAL ELECTRIC
COMMERCIAL GAS
ELECTRIC
GAS
Luxury all Monogram appliances
Memory Foam / Foam Mattress
UNIT NON RETURNABLE/NON REFUND
Microwave Advantium Style
Midline Bottom Freezer
Massage Chairs
Midline Counter Top mwo
MICROWAVE
Midline Dryer Electric
Midline Dryer Gas
Midline Dishwasher
Midline French Door
Midline Over the Range mwo
MICROWAVE PART
Midline Range Electric
Midline Range Gas
Midline Side by Side
UNIT NON RETURNABLE/NON REFUND
MICRO BUILT-IN
MICRO COUNTER TOP
MICRO DRAWER
MICRO OTC
MICRO OTR
Midline Washer
ACCESSORY
NON STANDARD SPECIALTY
ACCESSORY
REFRIGERATOR ESP
NOT DEFINED
OVER THE RANGE MICROWAVE
Plush Mattress
PARTS
Premium Bottom Freezer
Premium Dryer Electric
Premium Dryer Gas
Premium Dishwasher
PEDESTAL
Premium French Door
Plumbing
Pillows
Premium Over the Range mwo
Premium Range Electric
Premium Range Gas
Protectors
Premium Side by Side
Pillow Top / EPT Mattress
Premium Top Freezer
Premium Compact Refrigeration
Premium Washer
ACCESSORY
OLD RANGE ELECTRIC
OLD RANGE GAS
OLD REF ALL REF
OLD REF BM
OLD RANGE ELEC COIL
OLD Range Dual Fuel
RECLINER
REFRIGERATOR
REF ALL REF
REF BEV CENTER
REF BOTTOM BOUNT
REF COLUMN
OLD REF FRENCH DOOR
REF DRAWER
REF FRENCH DOOR
REF MINI FRIDGE
REFRIGERATOR
REF SIDE BY SIDE
REF TOP MOUNT
REF UNDER COUNTER
REF WINE COOLER
RANGE D/I COIL
RANGE D/I ELECTRIC
RANGE D/I DUAL FUEL
RANGE D/I GAS
RANGE D/I INDUCTION
RANGE F/S COIL
RANGE F/S DUAL FUEL
RANGE F/S ELECTRIC
RANGE F/S GAS
RANGE F/S INDUCTION
OLD Range Gas NIB
OLD Range Induction
RANGE S/I COIL
RANGE S/I DUAL FUEL
RANGE S/I ELECTRIC
RANGE S/I GAS
RANGE S/I INDUCTION
RANGE PART
OLD Smoothtop Electric Range
Refrigeration Side by Side NIB
RESTOCK FEE
ELECTRIC
GAS
OLD REF Top Mount NIB
OLD Refrigerator Compact
Scrap APPLIANCE PARTS
Sheets
OLD SLIDE IN ELECTRIC RANGE
OLD SLIDE IN GAS RANGE
Speciality Appliance
BUILT-IN
FREESTANDING
TRASH COMPACTOR
TEMPERARY CODE
WASHER - TOP LOAD
TELEVISION
USED DRYER ELECTRIC BASE
USED DRYER GAS BASE
USED DRYER ELECTRIC MIDLINE
USED DISHWASHER BASE
USED FRENCH DOOR
USED RANGE GAS MIDLINE
USED DISHWASHER MIDLINE
USED DRYER GAS MIDLINE
USED TOPMOUNT RERFRIGERATOR MI
USED SIDE BY SIDE MIDLINE
USED WASHER TOPLOAD MIDLINE
USED MICROWAVE
UNITIZED LAUNDRY
Upright Freezer
USED RANGE ELECTRIC BASE
USED RANGE GAS BASE
USED RANGE ELECTRIC MIDLINE
USED COOKING ASSORTED
USED APPLIANCE
USED STACKABLE GAS W/D
USED ASSORTED LAUNDRY
USED ELECTRIC STACK W/D
USED SPECIALITY APPL
USED BOTTOM MOUNT REFRIGERATOR
STAINLESS APPL
USED SIDE BY SIDE REF BASE
USED TOP MOUNT REF BASE
Unitized Washer dryer Electric
USED WASHER FRONTLOAD
Unitized Washer dryer Gas
USED WASHER TOPLOAD BASE
ACCESSORY
VACUUM
ROBOT
VACUUM
BLOWER
DOWNDRAFT
INSERT
ISLAND
OUTDOOR
UNDER CABINET HOOD
VENTILATION
WALL
COMMERCIAL FRONT LOAD WASHER
COMMERCIAL TOP LOAD WASHER
WASHER FL
WALLOVEN
WASHER PORTABLE
WASHER TL
BUILT-IN
FREE STANDING
WASHER - DRYER COMBO
OLD WARMING DRAWER
Water Heater Builder
WATER HEATER PART
WATERHEATERS
OLD Wall Oven Advantium NIB
WALL OVEN COMBO
WALL OVEN DOUBLE OVEN
WALL OVEN WARMING DRAWER
OLD Wall Oven Electric
OLD Wall Oven Gas NIB
Wall Oven Micro Combo
WALL OVEN PIZZA OVEN
WORK ORDER
WALL OVEN SINGLE OVEN
WALL OVEN SPEED OVEN / MW
WALL OVEN STEAM OVEN
WASHER PART
OLD WASHER
PRICE LIST IMPORT
GECAF PROMOTIION
PRICE MATCH
VENDOR SUPPORTED REDUCTION
MISC UNSPECIFIED
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.
IF THIS IS A WARRNTY, PLEASE PROVIDE THE DEALER THAT YOU PURCHASED THE APPLIANCE FROM:
Dealer:
APPLIANCE FACTORY
BEST BUY
CONNS
GENERAL ELECTRIC
HOME DEPOT
JC PENNYS
LOWES
MOUNTIAN HIGH APPLAINCES
NATIONAL SERVICE ALLIANCE
OTHER- ADD NOTE
WHIRLPOOL
If Dealer is not in the List:
City:
PROBLEM:
Request Date:
AM/PM:
AM
PM
(This is only a request. Someone will contact you shortly to schedule an appointment.)