FAX-Part Quote Request Form
All quotes are processed and replied to 24/7 .
You may fax this completed page 24 hours a day to: 1-777-222-2100. 
This form can be filled in manually or by computer.
To send a fax, right click your mouse on this order form and select 
PRINT from the drop down menu. To fax from your computer change
 the print setting to use your favorite system fax software.
Netscape sometimes view pages larger than normal if this happens change your print out
size settings to no bigger than 8x11.
You can fill this form out online or offline.
                                          
 
Please Complete Form Below. 
NOTE: We will never give out any information you exchange with us.
 
Type or write your email address here.
 
Your Name
 
Type of Product and brand.
Model Number (Off the appliance model tag). Need Help?

Some units, mostly Admiral or Amana have another number located on the same tag or 
sticker where the model number is. Serial, MFR - Manufacture, Service, Rev, Series, 
Catalog  or BM number. (Off the appliance model tag).
Approximate age of appliance?
Part Number/s (If known)?

Please specify where these numbers were found
so we can verify they are valid part numbers. Some 
numbers are simply patent codes with no value.

Daytime and Evening Phone, and your fax number.          
   

Please describe the part needed and where the part is located
on your unit. (For cosmetic items include the part color).

Comments: Problems with our site, etc.

Quotes are processed and replied to 7 days a week!

Fax this completed page to 1-777-222-2100. You may attach other pages if need be.