Third-Party Service Request

Please fill out the form below to request service.

For immediate assistance, please call us at 910-790-8585.

Step 1 of 3

Third-Party Payer

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

Paying Party(Required)

Requested by(Required)

First Last

Phone Number(Required)

Email Address for Invoice/Receipt(Required)

Company Billing Address(Required)

Street Address City State ZIP Code

Tenant & Work Order Information

Enter information about the tenant and service address.

Tenant(s) Name(Required)

First Last

Tenant's Phone Number(Required)

Vacant Property Access

Please provide details on how we should enter, along with information on key or code.

Service Address(Required)

Street Address City State ZIP Code

Product Being Serviced

Appliance Type(Required)

Appliance Brand(Required)

Model

Model Number

Purchase Date

Please Describe the Problem(Required)

Proof of Purchase or Other Related Documents (if applicable)

Max. file size: 256 MB.

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

Consent(Required)

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.

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