PAYMENT FORM FOR COMMERCIAL APPLIANCE REPAIR ESTIMATE

CUSTOMER INFO

Please enter a date and time for when it is most convenient for our Technician to visit your home. All Technician Repair estimates are $85 if you pay online prior to technician visit. There is no need to set up a PayPal Account. Just enter your credit/ debit card info through this secure form. This amount will be discounted from total cost of repairs if the customer hires Alma's Appliance for the repair service. All repairs come with a 30 day warranty.

Company Name

Contact - First Name

Last Name

Phone

Location of Appliance

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Date

Time

HOUR

MINUTE

AM/PM

Brand Name

Model Number

Did you purchase the appliance from Alma's Appliance?

Select Yes or No

true
false

Is the Appliance still under our warranty?

Select Yes or No

true
false

Enter a description as detailed as possible describing your appliance issue.

Billing Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Sub Total

$85.00

TOTAL

$85.00

Payment Method

Paypal

Credit Card Type

Select

Name on Card

Credit Card Number

Expiration Date

Month

Year

Verification Number

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ALMA'S APPLIANCE - PARTS & SERVICE

Ph. 956-412-3546

1722 N Commerce St.

Harlingen, TX 78552

email: info@almasappliance.com

We are also certified technicians for:

Hours of Operation:

Monday - Saturday

8:00 a.m. - 6:00 p.m.

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