Repair Form Service Request Please complete the fields below and a member of our Customer Service team will get back to you. CONTACT INFORMATIONRequester* Date* Order Number Age of Piece? Delivery Date Customer Name* Customer Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Number* Email Location of piece (if different from above) ADDITIONAL INFORMATIONDescribe the issue*Please include all details regarding the condition of the piece.Is the piece set in a very sunny area or exposed to extreme sunlight?* Yes No N/A Could it be sun-bleached?* Yes No N/A Does the piece of furniture get used daily or sparingly?* Daily Weekly Occasionally Is the piece a Thos. Moser Cabinetmakers product?*(We do not repair pieces that are not our product). Yes No In the opinon of the customer, what is the overall condition of the piece?* Poor Fair Good Very Good Excellent Photos of PieceInclude any photos you may have that show the condition of the piece. Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, zip, rar, doc, Max. file size: 20 MB. CommentsThis field is for validation purposes and should be left unchanged.