Michaelson's Online Service Call Request

Note: Fields marked must be filed in!

Warranty Coverage: No

Brand:

Type:

Age of appliance:

Other Brand if not on list:

Model Number if available:

Serial Number if available:

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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