Michaelson’s Service Request

Service Request Main Form

*Warranty Information, All information Required

Type:(Required)

Age of appliance:

Brand:

Other Brand if not on list:

Model Number if available:

Serial Number if available:

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)

Email:(Required)

Home Phone:(Required)

Cell Phone:

Work Phone:

Other Contact Name:

Other Home Phone:

Other Work Phone:

Other Cell Phone:

We normally respond within two hours during normal business hours.

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