Intake form

Help us serve you better

Name *

Email address *

What type of service do you need?

What brand is your laundry equipment?

Please select at least one option.

Whirlpool

Samsung

Maytag

Bosch

Frigidaire

Electrolux

What is the model number of your equipment?

What issue are you experiencing?

Preferred date for service appointment?

Preferred time for service appointment?

Is this for a residential or commercial appliance?

Phone number for contact?

Address of the service location?

Additional questions or comments

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Mejia Laundry Services LLC