Name, Address and Telephone Numbers for the Paying Party

Name, Address and Telephone Numbers for the Service Location (if different from above) Description of Symptoms and/or Customer's Request

Invoice Number

Date Order Taken and Completed

Purchase Date

Item Make and Type

Model and Serial Numbers

Service Performed

Parts Used

Record of Times at Location Parts Total

Service Call

Labor

Sales Tax

Invoice Total

Technician's Signature Customer Signature

Payments Received

LOWES EXTENDED WARRANTY # SLOL8RVSPD-1 22015

BUSH, MICHAEL

2667 BRADFORD DR

SAGINAW, MI 48603

989-***-****

8/23/18

8/30/18

FRIGIDAIRE

DISHWASHER

FBD2400KW10B

TH64016333

0.00

Dan T.

Bottom spinner jet arm spun out landed on heating element in dishwasher and melted a big hole

SPRAY ARM FELL OFF BURNT BY HEATER ORDER BY PHONE; ORDRNG 1-154****** (NUT,SPRAY ARM) AND 1-154****** (SPRAY ARM) REPLACED PARTS CKS OK HAD CUST SIGN FLOOR DAMAGE DONE PRIOR TO REPAIR HAD CUST SIGN FROM SPRAY ARM BLOWING OFFFRJMM; JOB CMPLTD

Samaritan Installation, Inc.

1365 E. Shaffer Rd

Hope, MI 48628

989-***-**** Voice, 888-***-**** Fax

1

1

154567702

154335201

spray arm [DT-8/30]

nut,spray arm [DT-8/30]

0.00

0.00

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