West Coast Appliance Repair

Customer Information

First Name	Last Name	Appoint. Date	Appointment Time

Address	City	Zip Code	Appliance Type

Home Phone	Alt. Phone	Email	Appliance Brand

Problem Descriptoon or Additional Information

I confirm that I am over 18 years old and I understand that there is a $35 estimate/diagnostic fee for most appliances, and $45 for central air conditioning or commercial units (waved upon repair completion)

Or Call us at

800-598-7320 323-845-0908
949-718-0393 714-521-5521