Appliance Extended Warranty Claim

Customer Name and Phone Number

Customers Name

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Customer Home Phone

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Customer Alt Phone

Email Address

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Customer's Address

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City

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Claim Information

Account Number (if available)

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Invoice Number (if available)

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Serial Number (if available)

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When did problem start?

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Description

What Appliance is Affected? Fridge Range/Oven/Cooktop Dishwasher Microwave Washer Dryer Freezer

Please tell us what appliance is affected.

What is wrong with the Fridge? Noisy Too Cold Not Cooling Does not run at all Ice Maker Leaking/Sweating/Condensation/Frost Other

Please tell us what is wrong with the Fridge.

Explain what is wrong?

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What is wrong with the Range/Oven/Cooktop? Burner Issues Noisy Control Panel Oven not working/Wrong temperature Preheating Issues Will not turn off No Power Self Cleaning Issues Other

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Explain what is wrong?

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What is wrong with the Dishwasher? Detergent Cup Issues Door Latch Issues Drain Issues Drying Issues Leaking/Flooding No Water Wash Performance (film or dirty dishes) Control Panel Top Rack Issues Other

Please tell us what is wrong with the Dishwasher.

Explain what is wrong?

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What is wrong with the Microwave? Controls/Power/Display Issues Cooking Issues Turntable Operation Venting Other

Please tell us what is wrong with the Microwave.

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What is wrong with the Washer? Not Draining Not Filling Water Level No Power Vibration Wash Performance Noisy Dispenser Issues Leaking Door Locked Other

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Explain what is wrong?

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What is wrong with the Dryer? Noisy Takes too long to dry Smell Gas (turn your gas off) Tumbles but does not heat Timer Issues No Power/Will not start Dryer stops or pauses Other

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Explain what is wrong?

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What is wrong with the Freezer? No Cool Leaking Other

Please tell us what is wrong with the Dryer.

Explain what is wrong?

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Brief description of what is not working?

What is not working?

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