Credit Card Authorization Form

Thank you for contacting Eastern Marketing Corp. in regard to your appliance that needs a Non-Warranty service repair.

Please note the following pricing policy:

Fees for Service in the Tri State Area (Suburban Areas)

$129 Diagnostic Fee (includes trip charge and, diagnostic)

$175 Labor Rate per hour. (1 hour minimum) Once Service is approved

Fees for Service in NYC all Boroughs, The Hamptons and East End

$225 Diagnostic Fee (includes trip charge and, diagnostic)

$225 Labor Rate per hour (1 hour minimum) Once Service is approved

If you are having multiple units serviced on the same day, you will only be charged one initial diagnostic charge. All additional charges will be based on time spent for additional appliances within that same service call.

Upon completion of the service call, the technician will ask for your credit card to be swiped on site. A final invoice will be emailed within 48hrs of job completion.

We do provide a 60-day limited repair warranty on our service.

**Please fill out the form below **

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Product Information:

Customer Service Rep.(Required)

Brand(Required)

Model # / Product Code(Required)

Serial #(Required)

Need help finding the label? View example

Need help finding the label? View example

Dealer / Retailer(Required)

Date of Purchase

I don't know the dealer name

I don’t know the dealer / retailer

Reason for Repair?(Required)

PLEASE NOTE: WE ONLY ACCEPT CREDIT CARDS FOR PAYMENT! CREDIT CARD # IS NEEDED PRIOR TO SCHEDULING REPAIR.

Name on Card(Required)

Credit Card #(Required)

Type of Card(Required)

CVC Code(Required)

Expiration Date(Required)

Is your billing address the same as your service address?(Required)

Yes

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

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