CyberOffice Scheduler
Online scheduling for

Online Scheduling for

Type of Job

What is the nature of this appointment?
New (it's my first request to you on this problem)
Continuation (the tech needs to finish work already started)
Recall (previous work failed to solve the problem)

Payment Structure

What is the payment situation?
Standard (you're personally responsible)
Original Manufacturer Warranty
Extended Warranty or Contract
Third-Party Payer

Service Area

So that we can let you know the particular days we're available in your area, please let us know your zip or postal code. *

Service Date

What is your preferred date of service? *
Do you prefer a particular time of day? *

About You

Asterisks ( * ) indicate required fields
First Name *
Last Name *
Email Address *
Street Address *
City *
State *
Phone Line 1 *
Phone Line 2

Product Being Serviced

Machine Make *
Machine Type *
Model Number *
Serial Number *
Selling Dealer *
Purchase Date *
Problem Description / Request for Service (100 characters remaining) *

Payment Type

How do you intend to pay for this service?
Cash
Check
Credit/Debit Card

Extended Warranty/Contract Provider

Name of Warranty/Contract Provider
Contract #
P.O./Warranty/Claim # (if applicable)

Third-Party Payer

Paying Organization (if applicable)
Contact's First Name *
Contact's Last Name *
Email Address *
Street Address *
City *
State *
Zip/Postal Code *
Phone Line 1 *
Phone Line 2

Continuation of work

If we previously did work but were unable to finish and required a subsequent visit, we would have sent you an email with a link to schedule a time for the technician to return. Please use the link we emailed so we can retrieve your information.

Recall

We're sorry you're having trouble. We work very hard to assure that every problem is fixed -- correctly and completely -- the first time.

As part of our effort to assure quality, we need to review each recall request before sending the technician back out.

Please, either call the office (), or email us () with a concise description of what you're encountering. We promise a prompt response.

Continuing signifies you have read and agree to the below statement:

I certify that I, , am the person now scheduling the service indicated. I certify that all information I've entered in the preceding steps of this form is true and correct, to the best of my knowledge. I understand that, based on my action here, will send a technician to the indicated location on the date shown above. I agree to fulfill all obligations as may properly and legally arise in connection with this order for service.

Schedule your appointment

You are scheduling for service at the following location:

LAST, FIRST
381 E ISLAND LAKE DR
SHELTON, WA 98584

Service is to be performed on your:

ROPER
ELDRICH

We are performing this service under order from , under their P.O. #.

What seems to be the problem?

Problem Description / Request for Service (100 characters remaining) * We received the following problem description when the request for service was made. Please make any changes you feel would help us in fulfilling service or press 'Next' to accept this description. (100 characters remaining) *

Who is scheduling?

Please enter your first and last name so we know who scheduled this appointment for service. *

Please confirm your appointment

Your date of service is: Tuesday, 1/21
Anticipated arrival time is: 1:00 - 3:00pm
Work is being performed at:



Reschedule
If you must reschedule, please call our office at

Not configured for direct scheduling

Please use the confirmation or scheduling link we sent you via email or SMS.
by Rossware