Request Service All fields mandatory Name (First & Last): E-mail: Phone: Address (Including Postal Code): Type of Appliance: Appliance Power Source: Electric | Gas Age of Appliance (years): -123456789101112131415161718192021222324252627282930 Brand: Problem with appliance: Is the appliance stacked? : -YesNo Preferred Service Date: Time Period Preferred: AM (8:00–12:00) PM (12:00-4:00) HAR will do its best to accommodate service dates but there is no guarantee. How did you hear about us? : -Search Engine/OnlineRadio/TVYellowpagesFriends/FamilySaw Our VanOther I understand by clicking on this box, I am providing my express consent to receive electronic communications including emails about new services and promotions from Home Appliance Repair Inc. I understand I may withdraw my consent at any time by emailing Home Appliance Repair Inc. I have read and agreed to the Terms and Conditions.