Are you a tenant of a property serviced by E&M?  Click here.

Your Name (required)

Your Email (required)

Street Address

Apartment?

YesNo

City:

State:

Zip:

Requested Date (click the black down arrow to use a calendar)

Requested Time:

Main Contact Phone Number:

Number of Appliances:

Appliance Type(s): (press ctrl to make multiple selections)

Appliance Brand(s): (press ctrl to make multiple selections)

Appliance 1 Model#

Appliance 2 Model#

Appliance 3 Model#

Appliance 1 Description of Problem(s):

Appliance 2 Description of Problem(s):

Appliance 3 Description of Problem(s):

NOTE: (SPECIAL CIRCUMSTANCES/NEEDS REQUEST – EXAMPLE – WORKS NIGHT SHIFT, CALL AFTER 1 P.M.; DOOR BELL BROKEN, KNOCK LOUDLY; PULL AROUND TO BACK DRIVE WAY; NEEDS SPECIAL HOURS, WORKS M-F 8-5.) E&M HOME SERVICE WILL TRY TO ACCOMMODATE SPECIAL CIRCUMSTANCES/NEEDS WHEN POSSIBLE.

How did you hear about us?

**COMPLETING THIS SERVICE REQUEST DOES NOT GUARANTEE YOU THE SELECTED DATE/TIME, WE WILL EITHER CALL YOU OR REPLY VIA EMAIL TO CONFIRM YOUR APPOINTMENT. ALL RIGHTS RESERVED.