Third-Party Service Request

Please fill-out this form to submit a third-party service request.

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Third-Party Payer Tenant & Work Order Product Being Serviced

Please complete the following information for the person and/or business responsible for paying the invoices related to this service request.

Paying Party *

Requested by *

Phone Number *

Email Address for Invoice/Receipt *

Company Billing Address *

Appliance Type *

Appliance Brand *

Model

Model Number

Purchase Date

Please Describe the Problem *

Proof of Purchase or Other Related Documents (if applicable)

Max. file size: 2 GB.

Note: If a credit card is needed on file, please call us at 910-790-8585 after form submission.

Consent *

Continuing signifies you have read and agree to the below statement:

I certify that all information I've entered in the preceding steps of this form is true and correct, to the best of my knowledge. Immediately after submission of this form, I will contact Island Appliance Repair to provide a credit card to keep on file, if payment is required. Based on my action here, I understand that Island Appliance Repair will attempt to schedule service. However, the date requested cannot be guaranteed. I agree to fulfill all obligations as may properly and legally arise in connection with this order for service.

Consent

I agree to the privacy policy.

In order to serve you better, we use various forms of communication including voice calls, email, and/or SMS (text messages). By scheduling service with us, you agree to our Digital Communication Policy, which states that you may receive SMS and email correspondence from Island Appliance Repair. No mobile information will be obtained from and/or shared with third parties or affiliates for marketing or promotional purposes. Message frequency varies & data rates may apply. Text STOP to cancel.

Third-Party Service Request

Request Submitted!

Note: If a credit card is needed on file, please call us at 910-790-8585 after form submission.