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contact
LOW RATES APPLIANCE REPAIR
Tel: 858-481-6163
760-432-0664
619-583-4455
Fax: 858-657-0575
Email:
lrappliances@san.rr.com
Name (enter first & last)
Resident Name (if different)
Email Address
Repair Address
Apt/Unit #
City
State
Select
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip
Phone (person booking)
Home
Work
Cell
Resident's Phone
Home
Work
Cell
Owner's Phone
Home
Work
Cell
For Landlords / Property Managers ONLY
Billing Address
Apt/Unit #
City
State
Select
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip
This section is for Billing Customers only, if you are not a billing customer skip this section and go to #3
Credit Card Numer
Visa
Mastercard
American Express
Discover
Credit Card Numer
Expiration Date
Name on Card
Brand of appliance
Not Listed or Don't Know (that's ok)
Admiral
Amana
Asko
Bosch
Caloric
Chambers
Coldspot
Dacor
Estate
Fisher Paykel
Frigidaire
Gaffers & Sattler
Gaggenau
General Electric
Gibson
Hotpoint
Insinkerator
Jenn-Air
Kelvinator
Kenmore
Kirkland
KitchenAid
Litton
Magic Chef
Maytag
Modern Maid
Norge
O'Keefe & Merrit
Penney's
Quasar
RCA
Roper
Samsung
Sanyo
Scottsman
Sears Brand
Sharp
Signature
Speed Queen
Subzero
Tappan
Thermador
Toshiba
Uline
Viking
Wards
Waste King
Wedgwood
Westinghouse
Whirlpool
Wolf
Viking
Not Listed or Don't Know (that's ok)
Type of Appliance:
Please Choose
Dishwasher
Dryer
Freezer
Garbage Disposer
Microwave
Oven
Range
Refrigerator
Stove
Trash Compactor
Washing Machine
Description of Problem
Requested Appointment Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Requested Appointment Time
Please select a time
Call Me To Arrange
Morning
Afternoon
7-9AM
8-10AM
9-11AM
10-12AM
11-1AM
12-2PM
12-2AM
1-3PM
2-4PM
3-5PM
4-6PM
5-7PM
Special Instructions or Directions
How will payment be made?
I will be there during appointment time.
Call Me 20 Minutes before arrival.
Set it up with my tenants, Call me for approval and bill me. (credit card guarantee required)
Set it up with my tenants, Call me for approval and charge my credit card.
PLEASE NOTE:
We will do whatever we can to honor your requested appointment date and time, however we cannot guarantee the current availability.
Questions? Contact Us...call us at 858-481-6163 ,760-432-0664 ,619-583-4455
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