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Information will be immediately submitted to our Service Department upon completion of this form and you will be contacted by Customer Service Representative within 1 hour during normal business hours or the next business day if your request was submitted after normal business hours.



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*First Name:
 		*Last Name:
   
*Address: 

     
City: State: Zip:
   
*Phone #:  *Alternative Phone #: 
   
*Appliance Type: Other
   
*Appliance Brand / Make: Other
   
*Appointment Date: *Appointment Time:

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*Problem Description: 

How did you hear about us: 

*E-mail:
 


Please Note: Appliance Service only Available in Los Angeles County and most of Ventura County











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