INFORMATION NEEDED TO BETTER SERVE YOU
(Information Needed To Get Service Started)

Online Service Request Form  Information Form

COMPLETE NAME:

COMPLETE ADDRESS:

HOME PHONE:

DAYTIME PHONE:

WORK PHONE:

CELL PHONE:

EMAIL ADDRESS:

BRAND: (ie.Panasonic, Sony)

MODEL NUMBER:

SERIAL NUMBER:

DOP: (date of purchase if warranty)

POP: (place of purchase if warranty)

COPY OF SALE RECEIPT: (if warranty)

DETAILED DISCRIPTION OF PROBLEM: (Digital Pictures if you have them)

THE ABOVE INFORMATION HELPS US SERVE YOU BETTER BY BEING ABLE TO CONNECT AND/OR CONTACT  YOU.

THANK YOU FOR THE OPPRITUNITY TO SERVE YOU AND YOUR PRODUCT.

WE DO NOT SALE OR PROVIDE YOUR INFORMATION TO ANYONE OUTSIDE THIS COMPANY THAT IS NOT INVOLVED WITH THE REPAIR SERVICE.


Copyright 2011 Homemakers Television Service
5902 E. Veterans Memorial Blvd, Killeen, Texas 76543