Pre-Paid Maintenance Availability Form: Please fill in all information, below, making sure to include all necessary contact information. We'll call you as soon as possible to schedule your service appointment. Name (Required): Service Address (Required): Mailing Address (if different): City (Required): State (Required): Zip Code (Required): Home Telephone Number (+ Area Code) (Required): Work Telephone Number (+ Area Code): Cell Phone Number (+ Area Code): Email Address: Dates You Are Available for a Service Call: From (mm/dd):     To (mm/dd): Note: Please be aware that the service dates you select are not guaranteed to be scheduled. Please wait for a final confirmation from our Service Department. Preferred Service Times (check as many as you like) 8:00 am    9:00 am - 12:00 pm    12:00 pm - 4:00 pm    Anytime    How shall we contact you? Call me at home Call me at work Call my cell phone Email me Send a letter When is the best time to contact you? Mornings are best Afternoons are best  Additional Information or Comments:

   ...........................................................................................
   © 2003 Joseph Frederick & Sons, 810 Stanton Road, Wilmington, DE 19804    (Tel) 302.994.5786    (Fax) 302.998.2401