New Service Request
Name of purchaser
First Name
Last Name
Has the furniture been removed from its original location?
Yes
No
If so, where was the furniture delivered?
Delivery date ( if you have it )
-
Month
-
Day
Year
Date
Did you purchase the product protection plan?
Yes
No
I Don't Know
Check all that apply:
Upholstery
Stationary
Motion
Fabric
Leather
Dining
Bedroom
Entertainment
Occasional
Mattress
Other
Select a choice:
Manufacturer Warranty
Product Protection Plan
Manufacturer: (if you know it)
E-mail
example@example.com
First and Last Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Details
Please describe in detail the issue that you believe is covered under either your Manufacturer or Extended Warranty as checked off above.
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