Service Request

Service Request

Please fill out the following information on this form and submit it to our In-House Service Department.

Note: It is important to provide as much information as possible when requesting service.

For repairs under Manufacture Warranty, a copy of your Proof of Purchase must be presented to our Technician prior to any service performed.
Service calls out of warranty require an Evaluation Fee determined at time of booking the service call.
A representative will explain our full service price structure with you.

Customer Information:
First Name	Last Name
Address 1	Address 2
City/Town	State	Zip
Home Phone	Work Phone
Cell Phone	E-Mail Address
Unit Information:
Brand	Type
Model #	Serial #
Date Purchased (If Warranty)
Who Referred you to Elwin
Brief Description of Problem