Name:

Address:

Phone:

Nature of the problem (be specific):

Which room of the house:

Make & model # of the appliance, if applicable:




Terms:
By submitting this request, I understand and agree that Venture Dynamics, LLC may enter my home to determine the appropriate action to complete this request for maintenance. I also understand and agree I am responsible for allowing access in a timely manner to the repair person who calls to schedule an appointment AND if access is not available at the appointed time, I may be charged a service call.