Appliance Repair
* Required Field
Unit for Repair
Unit:
Unit Description:
Unit Brand:	Demak Eastworld Honda Kawasaki MCR Suzuki Yamaha
Model:
		Under Warranty
Trouble Checklist (Please check the problems you encountered with the unit)
No Power Won't Eject For reprocessing No Picture Won't Open Won't Cool Intermittent Sound Stuck Up Disc Tape Paint scratched Discoloration Stuck Up Motor Disalign door Vertical One Line Noisy Motor Detached gasket Dead set with oscillation Stuck up Switch Open/melted cord For Check up For Cleaning Disaligned knob No Sound For Check up Grounded Distorted Sound Functured Evaporator Busted bulb Alignment of Mech. For installation Short Circuit Paint Fading Dented Body Cracked Cabinet
Others, Please Specify :
Client Information (Please fill-up the following fields for our record purposes.)
First Name:
Last Name :
Middle Name:
Gender:	Male Female
Province:	Abra Agusan del Norte Agusan del Sur Aklan Albay Antique Apayao Aurora Basilan Bataan Batanes Batangas Benguet Biliran Bohol Bukidnon Bulacan Cagayan Camarines Norte Camarines Sur Camiguin Capiz Catanduanes Cavite Cebu Compostela Valley Davao del Norte Davao del Sur Davao Oriental Eastern Samar Guimaras Ifugao Ilocos Norte Ilocos Sur Iloilo Isabela Kalinga Apayao La Union Laguna Lanao del Norte Lanao del Sur Leyte Maguindanao Marinduque Masbate Mindoro Occidental Mindoro Oriental Misamis Occidental Misamis Oriental Mountain Province NCR - 1st District NCR - 2nd District NCR - 3rd District NCR - 4th District Negros Occidental Negros Oriental North Cotabato Northern Samar Nueva Ecija Nueva Vizcaya Palawan Pampanga Pangasinan Quezon Province Quirino Province Rizal Romblon Sarangani Siquijor Sorsogon South Cotabato Southern Leyte Sultan Kudarat Sulu Surigao del Norte Surigao del Sur Tarlac Tawi-Tawi Wester Samar Zambales Zamboanga del Norte Zamboanga del Sur Zamboanga Sibugay
Municipality:	Bangued Boliney Bucay Bucloc Daguioman Danglas Dolores La Paz Lacub Lagayan Langagilang Langiden Licuan (Baay) Luba Malibcong Manabo Panarubia Pidigan Pilar Sal-Lapadan San Isidro San Juan San Quintin Tayum Tineg Tubo Villaviciosa
Barangay:
Street Address:
Contact numbers and email details. (please fill up at least one of the following)
E-mail:
Telephone No.:
Fax No.:
Mobile: