Repair Request Form

REPAIRS

-Request Form

REFERRALS

YOUR TESTIMONY

Repair Request Form

In order to expedite your request, please provide us the following information on your repair/warranty issue:

Homeowner's Name: (as it appears on original contract)
Home Phone:		Cell Phone:
Home Address:	City:	State:	Zip:
E-Mail Address:
Original Date on Contract:		Sales Representative:
Have we addressed this repair before?
If Yes, please tell us the date of the repair and what happened:
Are you the original purchaser of the product in need of repair?
Explain your repair issue as best you can:
Give specific directions as to the exact location of the area of concern on your house (designate north, south, east, west, front, back, which story, which room etc.)
Window Repairs: If your window needs parts, we will need you to provide the information from the warranty label. This label is located either on the window frame on the inside top or on the upper sash (below is an example of the warranty sticker):
Please provide the information for each window in need of repair.
Window #1 - Serial Number:		P.O. Number:
Date of Manufacture:		Size of Window:
Nature of repair or part that is broken:

Window #2 - Serial Number:		P.O. Number:
Date of Manufacture:		Size of Window:
Nature of repair or part that is broken:

Additional Repair Information:

Thank you for your cooperation in providing all of the necessary information to help us address your repair in an expedient manner. As soon as we review this information, we will contact you to inform you of our plan of action.

3320 N. 90th St. • Omaha, NE 68134 • 402.572.1144 • info@unitedservicesohi.com

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