Repair Request Form

Appliance Repair Request Form

Landlord/Prperty Manager Name *

First

Last

* Indicates required field

Tenant/ Resident Name *

First

Last

Address *

City *

Province *

Unit Number *

Postal Code *

Appliance Information

Model Number *

Serial Number *

Brand *

Type *

Preferred Contact Method *

Call Text Email

Phone Number *

Cell Number *

Email *

Is your Appliance Coin Operated? *

Yes No

Is your Appliance Gas or Electric *

Natural Gas Electric 240 VAC Electric 120 VAC

Other *

Location *

Other *

Accessable / Mobility *

Other *

Complaint/Fault

Power *

Nothing happens when it's turned on - no lights or sound It lights up,but won't run It clicks,but won't start It makes noise,but it's not doing what it's supposed to It runs for a short period of time, then stops It runs all the time and never stops

Other Issues *

Send Picture *

Max file size: 20MB

Submit

UA-27415110-1