Service Request

Your Name (required)

Your Email (required)

Your Phone (required)

Is this a cell phone?
YesNo

Street Address(required)

Apartment

YesNo

City

State

Zip

Appliances Repairs (Check as many as needed):

Cook TopDishwasherDisposalDryerFreezerIce MakerOvenRangeRefrigeratorWasherOther

If "Other" is selected, please specify here:

Please provide manufacturer, model number & describe issues:

Are there any special needs or requests?

Examples might include: "Work night shift", "Call after 1pm, please", "Door bell is broken, please knock loudly", "Pull around to back driveway", "Need special hours", "Work M-F, 8-5"

Appliance Repair Dallas will try to accommodate special circumstances and needs when possible.

**By clicking the checkbox, you understand that this Service Request DOES NOT guarantee you the date selected. We will call you or reply via email to confirm your appointment.** (Required)

I understand.

ALL RIGHTS RESERVED.