Salesperson's name*
Salesperson's email*
Store name and location*
Brand* —Please choose an option—AmanaAskoBertazzoniBlombergBOSCHBrigadeCoveDacorDanbyDCSElectroluxElicaFaberFisher & PaykelFrigidaireFulgorGaggenauGE AppliancesHuebschInglisJennairKenmoreKitchenAidLa CornueLacancheLGLynxMarvelMaytagMieleSamsungStirling MarathonSub ZeroThermadorVikingWhirlpoolWhite-WestinghouseWolfZephyr
Appliance type* —Please choose an option—Bar fridgeBarbecueCoffee machineCooktopDishwasherDown draft fanDryerFreezerHood-fanIce-makerMicrowaveRangeRefrigeratorWall ovenWasherWine-cooler
Warranty status* —Please choose an option—In warrantyOut of warranty
Serial number
Model number
Date of Purchase (D/M/Y)*
Issue with the appliance *
Please attach the customer's sales invoice. If possible, please also attach a photo of the label containing the model and serial number.
Customer's name*
Customer's email*
Customer's Phone number*
Secondary number
Street address*
Street address 2
City*
Postal code*
Province* AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon
Special instructions / Messages
Are there any special instructions or is there any important information we should know?
