APPLIANCE ORDER FORM

APPLIANCE ORDER FORM
Please call DeAnna at 724-705-3389 for delivery.
PROPERTY/CODE*
OAKMANOR 052-STOTLER 066-CREEKVIEW 068-SYCAMORE 130-PARK MANOR 183-CHATEAU 200-
Unit #*
Address*
City, State, Zip*
Refrigerator
Range
24" Dishwasher
White
APARTMENT MUST BE CLEANED AND PAINTED TO SUBMIT THIS FORM!!!!
Is the apartment rented?
YesNo
Date
MonthDayYear
Date
Did you Remove the old appliances?*
YesNoN/A
If possible, would you like the appliance company to remove the appliances?*
YESNoN/A
Important Notes
Signature
Clear
DATE
MonthDayYear
Date
EMAIL
example@example.com
Email
example@example.com
Should be Empty: