Intake form

Help us serve you better

Name *

Email address *

What type of appliance needs repair?

Please select at least one option.

Refrigerator

Washing Machine

Air Conditioner

Microwave

What issue are you experiencing with the appliance?

What is the brand of the appliance?

What is the model number of the appliance?

What is your ZIP code?

What is your preferred date for the service?

What is your preferred time for the service?

How did you hear about us?

Do you have any additional comments or questions?

Additional questions or comments

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ST Service Care