*ALL FIELDS ARE REQUIRED

Contact Information:

Name (First and Last please):

Street Address:

City:

State:  

5 digit Zip Code:  

Contact Phone:

*Note: We must be able to use this # between 8AM and 4:30PM Monday thru Friday.

Email:

Product Information:

Model#:

Serial#:

Original Sales Invoice #:

Delivery Date (MM/DD/YY):

Please describe your problem and include any reasons why you believe returning or exchanging the product is the best solution:

Have you contacted the manufacturer regarding this problem?   Yes No

Is this a recurring problem?   Yes No

if yes, how often?  

Has a Service Technician inspected this product?   Yes No

if yes, was it an Orville's Technician?   Yes No

if other, what service company?  

Have many Service Calls have you had on this product?   1 2 3 4 5+

When was your last Service Call?  

To your knowledge, have parts been ordered for this product to correct the problem?   Yes No I Don't Know