Secure Order Form

Let us ship the correct part the first time!

We respond to each and every Secure Order in a timely fashion. If your Order is not processed, your Email address and or Phone Number was incorrectly entered. Please double check these two important fields for accuracy. The Make and Model Number are also important fields. Without this information we will not be able to process your request. If you are having difficulty locating your Model Number, click on the Model Number Link. In most cases you will receive a response within 24 hours. If not please resubmit your request or call 1-570-622-6441 for assistance.

A final note....We receive numerous Orders per day and we have noticed very brief descriptions of the part(s) you are Ordering. Save us time and yourself by completing the following form in detail. We at Affordable Appliance take pride in what we do and in order for us to process your Secure Order professionally, we need accurate information. Please read our Disclaimer before proceeding.

Please provide the following contact information:

*First Name*
*Last Name*
*Street Address*
*Address (cont.)*
*City*
*State/Province*
*Zip Code*
*Country*
*Home Phone*
*Work Phone*
*E-mail*

Please provide the following product information:

Manufacture
Type of Appliance
Model *Number*
Batch Number
Manufactures Number
*Serial Number*

Parts Order:

Qty	Part Number	Description	Cost	Total Cost

Shipping Charges:
Total Order:

Special Comments or Instructions

Your Name on Credit Card
Type of Card
Credit Card Number	---
Expiration Date	-
Cid Number

Copyright © 2003-2004 [Affordable Appliance Service, Inc.]. All rights reserved.