Michaelson's Online Service Call Request

Note: Fields marked must be filed in!

Warranty Coverage: yes

Brand:

Type:

Age of appliance:

Model Number:

Serial Number:

Month:

Day:

Year:

Purchased At:

Do you have an Extended Warranty Contract? Yes No

If Yes, Extended warranty by who

Contract Number if Known

Please give a brief description of the problem with appliance:

Last Name:

First Name:

Street:

City:

State:

Zipcode:

Home Phone:

Work Phone:

Cell Phone:

Email:

Even when an appliance is assumed to be in warranty, A method of payment is required in case it is not covered by warranty.

Method of payment: Cash Check Visa - M/C

Other Contact Name:

Home Phone:

Work Phone:

Cell Phone:

We normally respond within two hours during normal bussiness hours.

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