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Submitter Information
Person Submitting Request
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Homeowner
Ferguson Representative
Ferguson Installer
Builder
Ferguson Sales Channel
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Residential
Builder/Multi-Family
Online
Builder Name
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Minto Homes
BOWA Builders
Other
Person Submitting Request Name
Are you the primary Point of Contact for this request?
Yes
No
Person Submitting Request Phone
Phone Type
Mobile
Home
Work
Person Submitting Request Email
Address Where Unit is Located
Is this a business?
Yes
No
City
State
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AL
AK
AA
AZ
AR
AE
AP
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
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KS
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ME
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MA
MI
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MS
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MT
NE
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NH
NJ
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OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
Is this Contact the Homeowner?
Secondary Contact Name
Secondary Contact Number
Phone Type
Mobile
Home
Work
Point of Contact Information
Is this Contact the Homeowner?
Contact Name
Contact Phone Number
Phone Type
Mobile
Home
Work
Contact Email
Is this Contact the Homeowner?
Secondary Contact Name
Secondary Contact Number
Phone Type
Mobile
Home
Work
Secondary Contact Email
Product
Service Request Type
Choose..
Customer Responsible (COD)
Extended Protection Plan
OEM/MFG Warranty
Other
Product
Choose..
Air Conditioner
Beverage Cooler
Coffee Maker
Coffee System
Commercial Appliance
Cooktop
Cooktop/Microwave
Cooktop - Steamer
Dehumidifier
Dish-Drawer
Dishwasher
Downdraft Blower
Dryer
Fireplace
Freezer
Garbage Disposal
Grill
Hood
Ice Maker
Kegerator
Laundry
Microwave
Microwave-Counter
Microwave/Wall Oven
Mini Split
Oven/Microwave/Warmer
Oven/Refrigerator
Range
Range/Microwave
Range/Refrigerator
Refrigerator
Rice Cooker
Trash Compactor
Vacuum
Wall Oven
Warming Drawer
Washer/Dryer
Washer-Front Load
Washer-Top Load
Washing Machine
Wine Cooler
Other Appliance
Other Combo Appliance
Installed by Ferguson
Yes
No
Manufacturer
Choose..
Acme
AGA
Alfresco
Amana
American Range
Arctic King
Ariston
Asko
Avallon
Avanti
Bertazzoni
Best
Blomberg
BlueStar
Bosch
Broan
Capital
COVE
CresCor
Crosley
Dacor
Daewoo
Danby
DCS
Delonghi
Dimplex
Edgestar
Electrolux
Elica
Elmira
Emerson
Estate
Eurocave
EuroChef
Faber
Fagor
Fedders
Fire Magic
Fisher Paykel
Fisher-Paykel
FISHER & PAYKEL
FiveStar
Fratelli
Friedrich
Frigidaire
Gaggenau
Garland
GE
Gibson
Goldstar
Haier
Heartland
Hotpoint
Insinkerator
JennAir
Kenmore
KitchenAid
Kobe
Koldfront
Kuppersbusch
La Cornue
LANDMARK
LG
Liebherr
Lynx
Magic Chef
Marvel
Maytag
Miele
Northland
NXR
OCI
Other Mfr
PeerlessPremier
Perlick
PREMIER
Prestige
Roper
Samsung
Scotsman
Sharp
Siemens
Sirius
Smeg
Speed Queen
Sub Zero
Summit
Tappan
Thermador
TurboChef
ULine
Vent-A-Hood
Verona
Viking
WasteKing
Weber
Whirlpool
Wolf
XO
Zephyr
Other Mfr
Model
Serial Number
Date Appliance Invoiced
Unit Number Where Product is Located
Installation/Closing Date
Selling Branch Number
Invoice Number
Detailed Product Failure Description
Comments
Preferred Service Provider
Preferred Services provider based on services network
Attach files
Attach delivery documents, closing documents, CCO- Any document verifying date customer took processing of the unit if over 30 days from invoice date. This will delay service if not provided upfront.
Attach More Files
** Attaching Proof of Purchase helps to avoid scheduling delays **
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