Service Call Request Form

Please fill in the form below to request a service call for your unit. You will be contacted by our service representatives as soon as your request is received and processed. Thank you for choosing Appliances and Electronics Repair for your service needs, we are very glad to have the opportunity to assist you.
Are you a returning customer?
Last Name
First Name
Day Time Phone #
Alternative Phone #
E-mail Address
Home Address
Zip Code
*Please Note: You must include Model #, Serial #, and Purchase Date if your unit is under manufacturer's warranty to avoid any delays in service.
Is the unit under warranty?
Unit Brand Name
Unit Model #
Unit Serial #
Product Type
If "Other", please specify Product Type
Purchase Date
Purchased From
Problem Description
Any additional units?
Please include the Brand Name, Model #, Serial #, Product Type, and Problem Description below if you do have an additional unit requiring service. (Model#, Serial #, and Purchase Date must be included for units under manufacturer's warranty)
Additional Unit Information