Please Tell Us About Your Appliance Repair Service Experience

Schedule / Request Service Online

This information is not intended as an offer to sell, or the solicitation of an offer to buy, a franchise. It is for information purposes only. Currently, the following states regulate the offer and sale of franchises: California, Hawaii, Illinois, Indiana, Maryland, Michigan, Minnesota, New York, North Dakota, Oregon, Rhode Island, South Dakota, Virginia, Washington and Wisconsin. If you are a resident of or want to locate a franchise in one of these states, we will not offer you a franchise unless and until we have complied with applicable pre-sale registration and disclosure requirements in your state.

No part of this Website can be reproduced without the written permission of Mr. Appliance® Corporation

© 2010 Mr. Appliance. All rights reserved.
Web Design and Search Engine Optimization by Mannix Marketing, Inc.

First Name: *
Last Name: *
E-mail Address: *
Phone:
Fax:
Address
Address: *
Address 2: (Apartment/Suite #)
City: *
State/Province: *
Zip/Postal Code: *
Survey Questions
Date of Service:
Name of Technician:
Will you call us again for service?	Yes No

How would you rate our office personnel?
1. Professional	Great	Good	Fair	Poor
2. Courteous	Great	Good	Fair	Poor
3. Helpful	Great	Good	Fair	Poor
4. Cheerful	Great	Good	Fair	Poor
5. Informative	Great	Good	Fair	Poor
6. Knowledgeable	Great	Good	Fair	Poor

How would you rate our technicians?
1. Prompt	Great	Good	Fair	Poor
2. Professional	Great	Good	Fair	Poor
3. Courteous	Great	Good	Fair	Poor
4. Cheerful	Great	Good	Fair	Poor
5. Appearance	Great	Good	Fair	Poor
6. Quality	Great	Good	Fair	Poor
7. Work Area	Great	Good	Fair	Poor

Customer Satisfaction Survey

Provide direct feedback on the appliance repair service you received

Contact Information

Address

Survey Questions

Why Mr. Appliance

My Home Life Newsletter

Questions or comments concerning your experience with us:
* - indicates required field