Thank you for connecting with us. We will respond to you shortly. 11https://easternmarketing.com/wp-content/plugins/nex-formsfalsemessagehttps://easternmarketing.com/wp-admin/admin-ajax.phphttps://easternmarketing.com/service-authorization-formyes1fadeInfadeOut Credit Card Authorization FormThank you for contacting Eastern Marketing Corp. in regard to your appliance that needs a Non-Warranty service repair. Please note the following pricing policy: Up to the first 30 minutes: $175.00 (regarding service, diagnostic, installation)- $30.00 for each additional 15 minutes after the first 30 minutes are completed- Parts used during call and tax will be charged as wellIf you are having multiple units serviced on the same day, you will only be charged one initial trip charge of $175. 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 the credit card and call our billing department to confirm the credit card number over the phone. A hold of $500 will be put on your card until the final invoice is billed. 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 information below and email this form back to us at your earliest convenience.***Name*Email*Address*City*State--- Select ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming*Zip CodeDaytime Phone Number*Brand--- Select ---BertazzoniBlombergXO*Model #*Serial #*Dealer*Reason for Repair?PLEASE NOTE: WE ONLY ACCEPT CREDIT CARDS FOR PAYMENT! CREDIT CARD # IS NEEDED PRIOR TO SCHEDULING REPAIR.*Type of Card--- Select ---VISAMASTERCARDAMERICAN EXPRESS*Name on Card*Credit Card Number*Expiration Date*CVC CodeSubmit