Michaelson’s Warranty Service Request

Service Request - Warranty Coverage: Yes

*Warranty Information, All information Required

Brand:

Type:(Required)

Age of appliance:(Required)

Model:

Serial:

Purchase Information:

Month:

Day:

Year:

Purchased At:

Do you have an Extended Warranty Contract?(Required)

Yes

If Yes, Extended warranty by who

Contract Number if Known

Please give a brief description of the problem with appliance:(Required)

Cliant Last Name:(Required)

Cliant First Name:(Required)

Your Address

Street:(Required)

City:(Required)

State:(Required)

Zipcode:(Required)

Cliant Home Phone:(Required)

Work Phone:

Cell Phone:

Email:(Required)

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:(Required)

Cash

Check

Visa - M/C

Other Contact Name:

Other Home Phone:

Other Work Phone:

Other Cell Phone:

We normally respond within two hours during normal business hours.