Tino's Tv Service Request Form

Service Request Form

Please use the form below to Request an In-House/Pick Up Service of your unit that is in need of repair.

Contact Info

Name: (First + Last)

Street Address:

City: State: Zip:

Home Phone: Cell:

Email:

Best Form of Contact:

E-Mail || Cell Phone || Home Phone

Unit Information:

Make: Model:

Serial Number: (If Available)

Purchase Date:

Under Warranty? Yes || No || Don't Know

Location of Television:
(i.e. 2nd floor, 3rd floor, Basement, Etc...)

Problem with the Unit:

Any Other Comments: