Service & Parts Request Order Form
Please fill out the form below. Entries are required for all fields marked with *.
Customer Account No. (existing customers only):
Service Request Type:
Existing customers may skip Section One (unless you want to change your contact information) and Proceed to Make Your Request
SECTION ONE
Enter Your Contact Information
Salutation:
Name:
*
E-Mail Address:
*
Company Name:
Job Title:
Address1:
*
Address2:
City:
*
State:
Postal Code:
Country:
Phone:
*
Alternate Phone:
Fax Number:
Website Address:
How did you hear of Belgrove Appliance, Inc.?

PROCEED TO MAKE YOUR REQUEST
For Stove Cleaning, Stove Restoration, Appliance Repair, Install or Appliance Removal Service: Go to Section Two

For Parts Purchase: Go to Section Three

For Appliance Purchase: Go to Section Four

SECTION TWO
Stove Cleaning, Stove Restoration, Appliance Repair,
Installation or Appliance Removal
Please select the kind of appliance you are requesting services for.   (Please note we do not repair microwaves, dehumidifiers, or vacuum cleaners).
Please select the brand name of the appliance you are requesting services for.
How many years old do you think your appliance is? Or how long have you had it?
What color is your appliance?
Describe in full detail your appliance (two side by side ovens, number of burners, cook-top, bottom freezer, refrigerator, etc.)
Describe the issue or request that you would like Belgrove Appliance, Inc. to handle for you. (Please include how long you have been experiencing this problem, and how and when the problem occurs, i.e., when you use the appliance, or does the problem exist when the appliance is not in use (gas smell when stove is off), etc.)
Please enter any other information you may find useful. (Optional)
If you would like to schedule an appointment at this moment, please enter the date(s) and time(s) by first, second and third choice. Please allow for a three hour service window from the time of your service request (i.e. 9am - 12pm).


A Belgrove Appliance, Inc. associate will contact you within the next 24-48 hours to discuss your request in further detail.
SECTION THREE
Parts Purchase
Part Name / Description
(black knob, etc.)

Part Number (if known)

Quantity
Other Information (Optional)

A Belgrove Appliance, Inc. associate will contact you within the next 24-48 hours to discuss your request in further detail.
 SECTION FOUR 
 Appliance Purchase
Brand Name
(GE, Whirlpool, etc.)
 I'm not sure
Type
(stove, washer, dryer, etc.)

Model Number
(if available)

Size
(inches or cubic feet)

   Inches Cubic Feet
Color
(white, stainless steel, etc.)
Other Information (Optional)
 
A Belgrove Appliance, Inc. associate will contact you within the next 24-48 hours to discuss your request in further detail.